IB 

Union Calendar No. 444 

115TH CONGRESS 

2D SESSION H. R. 4242 

[Report No. 115–585] 

To amend title 38, United States Code, to establish a permanent VA Care 

in the Community Program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 3, 2017 

Mr. ROE of Tennessee (for himself, Mr. COFFMAN, Mr. WENSTRUP, Mrs. 

RADEWAGEN, Mr. BOST, Mr. POLIQUIN, Mr. ARRINGTON, Mr. RUTHERFORD, Mr. HIGGINS of Louisiana, Mr. BERGMAN, Mr. BANKS of Indiana, 

Miss GONZA ́LEZ-COLO ́N of Puerto Rico, Mr. BILIRAKIS, Mr. DUNN, Mr. 

WALZ, Ms. KUSTER of New Hampshire, Miss RICE of New York, Mr. 

CORREA, Mr. SABLAN, Ms. ESTY of Connecticut, Mr. PETERS, Mr. 

O’ROURKE, Mr. TAKANO, and Ms. BROWNLEY of California) introduced 

the following bill; which was referred to the Committee on Veterans’ Affairs 

MARCH 5, 2018 

Additional sponsors: Mr. EMMER, Mr. STEWART, Mr. MESSER, Mr. HUDSON, 

Mr. JOHNSON of Ohio, and Mr. WEBSTER of Florida 

MARCH 5, 2018 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on November 3, 2017] 


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A BILL 

To amend title 38, United States Code, to establish a permanent VA Care in the Community Program, and for other 

purposes. 


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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the ‘‘VA 

5 Care in the Community Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—IMPROVED ACCESS FOR VETERANS TO NON-DEPARTMENT 

OF VETERANS AFFAIRS MEDICAL CARE 

Sec. 101. Assignment of veterans to primary care providers. 

Sec. 102. Establishment of VA Care in the Community Program. 

Sec. 103. Veterans Care Agreements. 

Sec. 104. Modification of authority to enter into agreements with State homes to 

provide nursing home care. 

Sec. 105. Department of Veterans Affairs electronic interface for processing of 

medical claims. 

Sec. 106. Funding for VA Care in the Community Program. 

Sec. 107. Termination of certain provisions authorizing medical care to veterans 

through non-Department of Veterans Affairs providers. 

Sec. 108. Implementation and transition. 

Sec. 109. Transplant procedures with live donors and related services. 

TITLE II—OTHER ADMINISTRATIVE MATTERS 

Sec. 201. Reimbursement for emergency ambulance services. 

Sec. 202. Improvement of care coordination for veterans through exchange of certain medical records. 

Sec. 203. Elimination of copayment offset. 

Sec. 204. Use of Department of Veterans Affairs Medical Care Collections Fund 

for certain improvements in collections. 

Sec. 205. Department of Veterans Affairs health care productivity improvement. 

Sec. 206. Licensure of health care professionals of the Department of Veterans Affairs providing treatment via telemedicine. 

Sec. 207. Establishment of processes to ensure safe opioid prescribing practices by 

non-Department of Veterans Affairs health care providers. 

Sec. 208. Assessment of health care furnished by the Department to veterans who 

live in the territories. 

Sec. 209. Oversight and accountability of financial processes of Department of 

Veterans Affairs. 

Sec. 210. Authority for Department of Veterans Affairs Center for Innovation for 

Care and Payment. 


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TITLE III—IMPROVEMENTS TO RECRUITMENT OF PHYSICIANS 

Sec. 301. Designated scholarships for physicians and dentists under Department 

of Veterans Affairs Health Professional Scholarship Program. 

Sec. 302. Establishment of Department of Veterans Affairs Specialty Education 

Loan Repayment Program. 

Sec. 303. Veterans healing veterans medical access and scholarship program. 

1 TITLE I—IMPROVED ACCESS FOR 

2 VETERANS TO NON-DEPART3 MENT OF VETERANS AFFAIRS 

4 MEDICAL CARE 

5 SEC. 101. ASSIGNMENT OF VETERANS TO PRIMARY CARE 

6 PROVIDERS. 

7 Section 1706 of title 38, United States Code, is amend8 ed by adding at the end the following new subsection: 

9 ‘‘(d)(1) Except as provided in section 1703A of this 

10 title, in furnishing primary care under this chapter, the 

11 Secretary shall assign each eligible veteran to— 

12 ‘‘(A) a patient-aligned care team of the Depart13 ment; or 

14 ‘‘(B) a dedicated primary care provider of the 

15 Department as a part of any other model of pro16 viding consistent primary care determined appro17 priate by the Secretary. 

18 ‘‘(2) Each patient-aligned care team of the Depart19 ment shall consist of a team of health care professionals of 

20 the Department who— 


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1 ‘‘(A) provide to each eligible veteran comprehen2 sive primary care in partnership with the veteran; 

3 and 

4 ‘‘(B) manage and coordinate comprehensive hos5 pital care and medical services consistent with the 

6 goals of care agreed upon by the veteran and team. 

7 ‘‘(3) The Secretary shall ensure that an eligible veteran 

8 is not simultaneously assigned to more than one patient9 aligned care team or dedicated primary care provider 

10 under this subsection at a single location, including by es11 tablishing procedures in the event a primary care provider 

12 retires or is otherwise no longer able to treat the veteran. 

13 In the case of an eligible veteran who resides in more than 

14 one location, the Secretary may assign such veteran to a 

15 patient-aligned care team or dedicated primary care pro16 vider at each such location. 

17 ‘‘(4) The term ‘eligible veteran’ means a veteran who— 

18 ‘‘(A) is enrolled in the patient enrollment system 

19 of the Department established and operated under sec20 tion 1705(a) of this title; and 

21 ‘‘(B) has— 

22 ‘‘(i) been furnished hospital care or medical 

23 services at or through a Department facility on 

24 at least one occasion during the two-year period 


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1 preceding the date of the determination of eligi2 bility; or 

3 ‘‘(ii) requested a first-time appointment for 

4 hospital care or medical services at a Depart5 ment facility.’’. 

6 SEC. 102. ESTABLISHMENT OF VA CARE IN THE COMMUNITY 

7 PROGRAM. 

8 (a) ESTABLISHMENT OF PROGRAM.— 

9 (1) IN GENERAL.—Chapter 17 of title 38, United 

10 States Code, is amended by inserting after section 

11 1703 the following new section: 

12 ‘‘§ 1703A. VA Care in the Community Program 

13 ‘‘(a) PROGRAM.—(1) Subject to the availability of ap14 propriations for such purpose, hospital care, medical serv15 ices, and extended care services under this chapter shall be 

16 furnished to an eligible veteran through contracts or agree17 ments authorized under subsection (d), or contracts or 

18 agreements, including national contracts or agreements, au19 thorized under section 8153 of this title or any other provi20 sion of law administered by the Secretary, with network 

21 providers for the furnishing of such care and services to vet22 erans. 

23 ‘‘(2) Subject to subsection (b), an eligible veteran may 

24 select a provider of such care or services from among net25 work providers. 


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1 ‘‘(3) The Secretary shall coordinate the furnishing of 

2 care and services under this section to eligible veterans. 

3 ‘‘(4)(A) In carrying out this section, the Secretary 

4 shall establish regional networks of network providers. The 

5 Secretary shall determine, and may modify, such regions 

6 based on the capacity and market assessments of Veterans 

7 Integrated Service Networks conducted under subsection (k) 

8 or upon recognized need. 

9 ‘‘(B) The Secretary may enter into one or more con10 tracts for the purposes of managing the operations of the 

11 regional networks and for the delivery of care pursuant to 

12 this section. 

13 ‘‘(C) The Secretary shall— 

14 ‘‘(i) verify upon enrollment, and annually there15 after, that network providers have not been excluded 

16 from participation in other federally funded health 

17 care programs; and 

18 ‘‘(ii) submit to the Committees on Veterans’ Af19 fairs of the House of Representatives and the Senate 

20 an annual report on the results of such verifications. 

21 ‘‘(b) PRIMARY AND SPECIALTY CARE.—(1)(A) If the 

22 Secretary is unable to assign an eligible veteran to a pa23 tient-aligned care team or dedicated primary care provider 

24 under section 1706(d) of this title because the Secretary deVerDate Sep 11 2014 20:57 Mar 05, 2018 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6203 E:\BILLS\H4242.RH H4242

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1 termines such a care team or provider at a Department 

2 facility is not available— 

3 ‘‘(i) the Secretary shall consult with the veteran 

4 regarding available primary care providers from 

5 among network providers that are located in the re6 gional network in which the veteran resides or a re7 gional network that is adjacent to the regional net8 work in which the veteran resides; and 

9 ‘‘(ii) the veteran may select one of the available 

10 primary care providers to serve as the dedicated pri11 mary care provider of the veteran. 

12 ‘‘(B) In determining whether a patient-aligned care 

13 team or dedicated provider under section 1706(d) of this 

14 title is available for assignment to a veteran, the Secretary 

15 shall take into consideration each of the following: 

16 ‘‘(i) Whether the veteran faces an unusual or ex17 cessive burden in accessing such patient-aligned care 

18 team or dedicated provider at a medical facility of 

19 the Department including with respect to— 

20 ‘‘(I) geographical challenges; 

21 ‘‘(II) environmental factors, including roads 

22 that are not accessible to the general public, traf23 fic, or hazardous weather; 

24 ‘‘(III) a medical condition of the veteran; or 


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1 ‘‘(IV) such other factors as determined by 

2 the Secretary. 

3 ‘‘(ii) Whether the veteran reasonably believes that 

4 the assignment of a particular care team or provider 

5 to the veteran would detrimentally affect the patient6 provider relationship and result in sub-optimal care 

7 to the veteran. 

8 ‘‘(iii) Whether the panel size of the care team or 

9 provider is at such a number that it would result in 

10 difficulty for the veteran in accessing timely care or 

11 in sub-optimal care to the veteran. 

12 ‘‘(iv) Whether the veteran resides in a State 

13 where the Department does not operated a full-service 

14 medical facility. 

15 ‘‘(C) If the Secretary determines that a patient-aligned 

16 care team or dedicated primary care provider at a Depart17 ment facility has become available for assignment to an eli18 gible veteran who had been assigned to a network provider 

19 under subparagraph (A), the Secretary shall provide the 

20 veteran with the option of reassignment to the team or pro21 vider at the Department facility. 

22 ‘‘(D) In the case of an eligible veteran who is assigned 

23 to a network provider under subparagraph (A), the Sec24 retary shall reevaluate such assignment not earlier than one 


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1 year after a veteran makes a selection under subparagraph 

2 (A)(ii), and on an annual basis thereafter, to— 

3 ‘‘(i) determine whether the Secretary is able to 

4 assign to the veteran a patient-aligned care team or 

5 dedicated primary care provider under section 

6 1706(d) of this title; and 

7 ‘‘(ii) in consultation with and upon approval of 

8 the veteran, make such assignment if able. 

9 ‘‘(2)(A)(i) Except as provided in clause (ii), the Sec10 retary may only furnish specialty hospital care, medical 

11 services, or extended care services to an eligible veteran 

12 under this section pursuant to a referral for such specialty 

13 care or services made by the primary care provider of the 

14 veteran. 

15 ‘‘(ii) The Secretary may designate specialties which 

16 shall be exempt from the requirement under clause (i). 

17 ‘‘(B) The Secretary shall determine whether to furnish 

18 specialty hospital care, medical services, or extended care 

19 services to an eligible veteran pursuant to subparagraph 

20 (A)— 

21 ‘‘(i) at a medical facility of the Department that 

22 is within a reasonable distance of the residence of the 

23 veteran, as determined by the Secretary; 

24 ‘‘(ii) by a network provider that, to the greatest 

25 extent practicable, is located in the regional network 


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1 in which the veteran resides or a regional network 

2 that is adjacent to the regional network in which the 

3 veteran resides; or 

4 ‘‘(iii) pursuant to an agreement described in 

5 subparagraph (C). 

6 ‘‘(C) An agreement described in this subparagraph is 

7 an agreement entered into by the Secretary with a network 

8 provider under which— 

9 ‘‘(i) specialty hospital care, medical services, or 

10 extended care services are furnished to an eligible vet11 eran pursuant to subparagraph (A)— 

12 ‘‘(I) at a medical facility of the Department 

13 by a network provider possessing the appropriate 

14 credentials, as determined by the Secretary; or 

15 ‘‘(II) at a facility of a network provider by 

16 a health care provider of the Department; and 

17 ‘‘(ii) such specialty care or services are so fur18 nished either— 

19 ‘‘(I) in accordance with this section with re20 spect to fees and payments for care and services 

21 furnished under subsection (a); or 

22 ‘‘(II) at no cost to the United States. 

23 ‘‘(D) In making the determination under subpara24 graph (B), the Secretary shall give priority to medical faVerDate Sep 11 2014 20:57 Mar 05, 2018 Jkt 079200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\H4242.RH H4242

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1 cilities and health care providers of the Department but 

2 shall take into account— 

3 ‘‘(i) whether the veteran faces an unusual or ex4 cessive burden in accessing such specialty hospital 

5 care, medical services, or extended care services at a 

6 medical facility of the Department, including with re7 spect to— 

8 ‘‘(I) geographical challenges; 

9 ‘‘(II) environmental factors, such as roads 

10 that are not accessible to the general public, traf11 fic, or hazardous weather; 

12 ‘‘(III) a medical condition of the veteran; or 

13 ‘‘(IV) such other factors as determined by 

14 the Secretary; 

15 ‘‘(ii) whether the primary care provider of the 

16 veteran recommends that such specialty hospital care, 

17 medical services, or extended care services should be 

18 furnished by a network provider; 

19 ‘‘(iii) whether the veteran resides in a State 

20 where the Department does not operate a full-service 

21 medical facility; and 

22 ‘‘(iv) in the case of a veteran who requires an 

23 organ or bone marrow transplant, whether the veteran 

24 has, in the opinion of the primary care provider of 

25 the veteran, a medically compelling reason to travel 


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1 outside the region of the Organ Procurement and 

2 Transplantation Network, established under section 

3 372 of the National Organ Transplantation Act (Pub4 lic Law 98–507; 42 U.S.C. 274), in which the veteran 

5 resides, to receive such transplant. 

6 ‘‘(E) The Secretary shall ensure that each medical fa7 cility of the Department processes referrals for specialty 

8 hospital care, medical services, or extended care services in 

9 a standardized manner, including with respect to the orga10 nization of the program office responsible for such referrals. 

11 ‘‘(F) In carrying out this section, the Secretary shall 

12 establish a process to review any disagreement between an 

13 eligible veteran and the Department, or between an eligible 

14 veteran and a health care provider of the Department, re15 garding the eligibility of the veteran to receive care or serv16 ices from a network provider under this section or the as17 signment of a primary care provider of the Department to 

18 the veteran. In reviewing a disagreement under such process 

19 with respect to the availability of and assignment to a pa20 tient aligned care team or dedicated primary care provider, 

21 the Secretary may give deference to the veteran with respect 

22 to any determination under subsection (b)(1)(B)(ii). 

23 ‘‘(G)(i) The Secretary shall develop procedures to en24 sure that assigning a veteran to a patient-aligned care team 

25 or dedicated primary care provider under subparagraph 


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1 (A), (C), or (D) does not adversely affect the continuity or 

2 quality of care for the veteran during the transition. 

3 ‘‘(ii) Procedures under clause (i) shall provide for— 

4 ‘‘(I) the appointment of a contact in the Depart5 ment for the veteran who shall provide information to 

6 the veteran and resolve issues regarding the transi7 tion; 

8 ‘‘(II) the transfer of relevant medical records; 

9 ‘‘(III) coordination of care between providers; 

10 ‘‘(IV) the continued treatment of chronic or cur11 rent episodes of care (by means including medication, 

12 subspecialty care, and ancillary services); and 

13 ‘‘(V) any other action the Secretary determines 

14 is necessary. 

15 ‘‘(c) EPISODES OF CARE.—(1) The Secretary shall en16 sure that, at the election of an eligible veteran who receives 

17 hospital care, medical services, or extended care services 

18 from a network provider in an episode of care under this 

19 section, the veteran receives such care or services from that 

20 network provider, another network provider selected by the 

21 veteran, or a health care provider of the Department, 

22 through the completion of the episode of care, including all 

23 specialty and ancillary services determined necessary by the 

24 provider as part of the treatment recommended in the 

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1 tion with respect to necessary specialty and ancillary serv2 ices provided by a network provider, the network provider 

3 shall consult with the Secretary, acting through the pro4 gram office of the appropriate medical facility. 

5 ‘‘(2) In cases of episodes of care that the Secretary de6 termines case management to be appropriate, the Secretary 

7 shall provide case management to an eligible veteran who 

8 receives hospital care, medical services, or extended care 

9 services from a network provider for such episodes of care. 

10 The Secretary may provide such case management through 

11 the Veterans Health Administration or through an entity 

12 that manages the operations of the regional networks pursu13 ant to subsection (a)(4)(B). 

14 ‘‘(d) CARE AND SERVICES THROUGH CONTRACTS AND

15 AGREEMENTS.—(1) The Secretary shall enter into contracts 

16 or agreements, including national contracts or agreements 

17 for, but not limited to, dialysis, for furnishing care and 

18 services to eligible veterans under this section with network 

19 providers. 

20 ‘‘(2)(A) In entering into a contract or agreement under 

21 paragraph (1) with a network provider, the Secretary 

22 shall— 

23 ‘‘(i) negotiate rates for the furnishing of care and 

24 services under this section; and 


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1 ‘‘(ii) reimburse the provider for such care and 

2 services at the rates negotiated pursuant to clause (i) 

3 as provided in such contract or agreement. 

4 ‘‘(B)(i) Except as provided in paragraph (3), rates ne5 gotiated under subparagraph (A)(i) shall not be more than 

6 the rates paid by the United States to a provider of services 

7 (as defined in section 1861(u) of the Social Security Act 

8 (42 U.S.C. 1395x(u))) or a supplier (as defined in section 

9 1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medi10 care Program under title XVIII of the Social Security Act 

11 (42 U.S.C. 1395 et seq.) for the same care or services. 

12 ‘‘(ii) In determining the rates under the Medicare Pro13 gram under title XVIII of the Social Security Act (42 

14 U.S.C. 1395 et seq.) for purposes of clause (i), in the case 

15 of care or services furnished by a provider of services with 

16 respect to which such rates are determined under a fee 

17 schedule to which the area wage index under section 

18 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 

19 1395ww(d)(3)(E)) applies, such area wage index so applied 

20 to such provider of services may not be less than 1.00. 

21 ‘‘(C) In carrying out paragraph (2), the Secretary 

22 may incorporate the use of value-based reimbursement mod23 els to promote the provision of high-quality care. 

24 ‘‘(3)(A) With respect to the furnishing of care or serv25 ices under this section to an eligible veteran who resides 


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1 in a highly rural area (as defined under the rural-urban 

2 commuting area codes developed by the Secretary of Agri3 culture and the Secretary of Health and Human Services), 

4 the Secretary of Veterans Affairs may negotiate a rate that 

5 is more than the rate paid by the United States as described 

6 in paragraph (2)(B). 

7 ‘‘(B) With respect to furnishing care or services under 

8 this section in Alaska, the Alaska Fee Schedule of the De9 partment of Veterans Affairs will be followed, except for 

10 when another payment agreement, including a contract or 

11 provider agreement, is in place. 

12 ‘‘(C) With respect to furnishing care or services under 

13 this section in a State with an All-Payer Model Agreement 

14 under the Social Security Act that became effective on or 

15 after January 1, 2014, the Medicare payment rates under 

16 paragraph (2)(B) shall be calculated based on the payment 

17 rates under such agreement, or any such successor agree18 ment. 

19 ‘‘(D) With respect to furnishing care or services under 

20 this section in a location in which the Secretary determines 

21 that adjusting the rate paid by the United States as de22 scribed in paragraph (2)(B) is appropriate, the Secretary 

23 may negotiate such an adjusted rate. 

24 ‘‘(E) With respect to furnishing care or services under 

25 this section in a location or in a situation in which an 


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1 exception to the rates paid by the United States under the 

2 Medicare Program under title XVIII of the Social Security 

3 Act (42 U.S.C. 1395 et seq.) for the same care or services 

4 applies, the Secretary may follow such exception. 

5 ‘‘(F) With respect to furnishing care or services under 

6 this section for care or services not covered under the Medi7 care Program under title XVIII of the Social Security Act 

8 (42 U.S.C. 1395 et seq.), the Secretary shall establish a 

9 schedule of fees for such care or services. 

10 ‘‘(G) With respect to furnishing care or services under 

11 this section pursuant to an agreement with a tribal or Fed12 eral entity, the Secretary may negotiate a rate that is more 

13 than the rate paid by the United States as described in 

14 paragraph (2)(B). 

15 ‘‘(4) For the furnishing of care or services pursuant 

16 to a contract or agreement under paragraph (1), a network 

17 provider may not collect any amount that is greater than 

18 the rate negotiated pursuant to paragraph (2)(A). 

19 ‘‘(5)(A) If, in the course of an episode of care under 

20 this section, any part of care or services is furnished by 

21 a medical provider who is not a network provider, the Sec22 retary may compensate such provider for furnishing such 

23 care or services. 

24 ‘‘(B) The Secretary shall make reasonable efforts to 

25 enter into a contract or agreement under this section with 


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1 any provider who is compensated pursuant to subpara2 graph (A). 

3 ‘‘(e) PROMPT PAYMENT STANDARD.—(1) The Sec4 retary shall ensure that claims for payments for hospital 

5 care, medical services, or extended care services furnished 

6 under this section are processed in accordance with this sub7 section, regardless of whether such claims are— 

8 ‘‘(A) made by a network provider to the Sec9 retary; 

10 ‘‘(B) made by a network provider to a regional 

11 network operated by a contractor pursuant to sub12 section (a)(4)(B); or 

13 ‘‘(C) made by such a regional network to the 

14 Secretary. 

15 ‘‘(2) A covered claimant that seeks payment for hos16 pital care, medical services, or extended care services fur17 nished under this section shall submit to the covered payer 

18 a claim for payment not later than— 

19 ‘‘(A) with respect to a claim by a network pro20 vider, 180 days after the date on which the network 

21 provider furnishes such care or services; or 

22 ‘‘(B) with respect to a claim by a regional net23 work operated by a contractor, 180 days after the 

24 date on which the contractor pays the network pro25 vider for furnishing such care or services. 


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1 ‘‘(3) Notwithstanding chapter 39 of title 31 or any 

2 other provision of law, the covered payer shall pay a covered 

3 claimant for hospital care, medical services, or extended 

4 care services furnished under this section— 

5 ‘‘(A) in the case of a clean claim submitted to 

6 the covered payer on paper, not later than 45 cal7 endar days after receiving the claim; or 

8 ‘‘(B) in the case of a clean claim submitted to 

9 the covered payer electronically, not later than 30 cal10 endar days after receiving the claim. 

11 ‘‘(4)(A) If the covered payer denies a claim submitted 

12 by a covered claimant under paragraph (1), the covered 

13 payer shall notify the covered claimant of the reason for 

14 denying the claim and the additional information, if any, 

15 that may be required to process the claim— 

16 ‘‘(i) in the case of a clean claim submitted to the 

17 covered payer on paper, not later than 45 calendar 

18 days after receiving the claim; or 

19 ‘‘(ii) in the case of a clean claim submitted to 

20 the covered payer electronically, not later than 30 cal21 endar days after receiving the claim. 

22 ‘‘(B) Upon receipt by the covered payer of additional 

23 information specified under subparagraph (A) relating to 

24 a claim, the covered payer shall pay, deny, or otherwise 


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1 adjudicate the claim, as appropriate, not later than 30 cal2 endar days after receiving such information. 

3 ‘‘(5)(A) If the covered payer has not paid a covered 

4 claimant or denied a clean claim for payment by the cov5 ered claimant under this subsection during the appropriate 

6 period specified in this subsection, such clean claim shall 

7 be considered overdue. 

8 ‘‘(B) If a clean claim for payment by a covered claim9 ant is considered overdue under subparagraph (A), in addi10 tion to the amount the covered payer owes the covered 

11 claimant under the claim, the covered payer shall owe the 

12 covered claimant an interest penalty amount that shall— 

13 ‘‘(i) be prorated daily; 

14 ‘‘(ii) accrue from the date the payment was over15 due; 

16 ‘‘(iii) be payable at the time the claim is paid; 

17 and 

18 ‘‘(iv) be computed at the rate of interest estab19 lished by the Secretary of the Treasury, and published 

20 in the Federal Register, for interest payments under 

21 subsections (a)(1) and (b) of section 7109 of title 41 

22 that is in effect at the time the covered payer accrues 

23 the obligation to pay the interest penalty amount. 


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1 ‘‘(6)(A) If the covered payer overpays a covered claim2 ant for hospital care, medical services, or extended care 

3 services furnished under this section— 

4 ‘‘(i) the covered payer shall deduct the amount of 

5 any overpayment from payments due to the covered 

6 claimant after the date of such overpayment; or 

7 ‘‘(ii) if the covered payer determines that there 

8 are no such payments due after the date of the over9 payment, the covered claimant shall refund the 

10 amount of such overpayment not later than 30 days 

11 after such determination. 

12 ‘‘(B)(i) Before deducting any amount from a payment 

13 to a covered claimant under subparagraph (A), the covered 

14 payer shall ensure that the covered claimant is provided 

15 an opportunity— 

16 ‘‘(I) to dispute the existence or amount of any 

17 overpayment owed to the covered payer; and 

18 ‘‘(II) to request a compromise with respect to 

19 any such overpayment. 

20 ‘‘(ii) The covered payer may not make any deduction 

21 from a payment to a covered claimant under subparagraph 

22 (A) unless the covered payer has made reasonable efforts 

23 to notify the covered claimant of the rights of the covered 

24 claimant under subclauses (I) and (II) of clause (i). 


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1 ‘‘(iii) Upon receiving a dispute under subclause (I) of 

2 clause (i) or a request under subclause (II) of such clause, 

3 the covered payer shall make a determination with respect 

4 to such dispute or request before making any deduction 

5 under subparagraph (A) unless the time required to make 

6 such a determination would jeopardize the ability of the 

7 covered payer to recover the full amount owed to the covered 

8 payer. 

9 ‘‘(7) Notwithstanding any other provision of law, the 

10 Secretary may, except in the case of a fraudulent claim, 

11 false claim, or misrepresented claim, compromise any claim 

12 of an amount owed to the United States under this section. 

13 ‘‘(8) This subsection shall apply only to payments 

14 made on a claims basis and not to capitation or other forms 

15 of periodic payments to network providers. 

16 ‘‘(9) A network provider that provides hospital care, 

17 medical services, or extended care services to an eligible vet18 eran under this section may not seek any payment for such 

19 care or services from the eligible veteran. 

20 ‘‘(10) With respect to making a payment for hospital 

21 care or medical services furnished to an eligible veteran by 

22 a network provider under this section— 

23 ‘‘(A) the Secretary may not require receipt by 

24 the veteran or the Department of a medical record 

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1 fore a covered payer makes a payment for such care 

2 or services; and 

3 ‘‘(B) the Secretary may require that the network 

4 provider attests to such care or services so provided 

5 before a covered payer makes a payment for such care 

6 or services. 

7 ‘‘(f) COST-SHARING.—(1) The Secretary shall require 

8 an eligible veteran to pay a copayment for the receipt of 

9 care or services under this section only if such eligible vet10 eran would be required to pay a copayment for the receipt 

11 of such care or services at a medical facility of the Depart12 ment or from a health care provider of the Department 

13 under this chapter. 

14 ‘‘(2) The amount of a copayment charged under para15 graph (1) may not exceed the amount of the copayment that 

16 would be payable by such eligible veteran for the receipt 

17 of such care or services at a medical facility of the Depart18 ment or from a health care provider of the Department 

19 under this chapter. 

20 ‘‘(3) In any case in which an eligible veteran is fur21 nished hospital care or medical services under this section 

22 for a non-service-connected disability described in sub23 section (a)(2) of section 1729 of this title, the Secretary shall 

24 recover or collect reasonable charges for such care or services 


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1 from a health-plan contract described in section 1705A in 

2 accordance with such section 1729. 

3 ‘‘(g) MEDICAL RECORDS.—(1) The Secretary shall en4 sure that any network provider that furnishes care or serv5 ices under this section to an eligible veteran— 

6 ‘‘(A) upon the request of the veteran, provides to 

7 the veteran the medical records related to such care or 

8 services; and 

9 ‘‘(B) upon the completion of the provision of 

10 such care or services to such veteran, provides to the 

11 Department the medical records for the veteran fur12 nished care or services under this section in a time13 frame and format specified by the Secretary for pur14 poses of this section, except the Secretary may not re15 quire that any payment by the Secretary to the eligi16 ble provider be contingent on such provision of med17 ical records. 

18 ‘‘(2) To the extent practicable, the Secretary shall sub19 mit to a network provider that furnishes care or services 

20 under this section to an eligible veteran the medical records 

21 of such eligible veteran that are maintained by the Depart22 ment and are relevant to such care or services. 

23 ‘‘(3) To the extent practicable, the Secretary shall— 

24 ‘‘(A) ensure that the medical records shared 

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1 tronic format accessible by network providers and the 

2 Department through an Internet website; and 

3 ‘‘(B) provide to network providers access to the 

4 electronic patient health record system of the Depart5 ment, or successor system, for the purpose of fur6 nishing care or services under this section. 

7 ‘‘(h) USE OF CARD.—The Secretary shall ensure that 

8 the veteran health identification card, or such successor 

9 identification card, includes sufficient information to act 

10 as an identification card for an eligible entity or other non11 Department facility. The Secretary may not use any 

12 amounts made available to the Secretary to issue separate 

13 identification cards solely for the purpose of carrying out 

14 this section. 

15 ‘‘(i) PRESCRIPTION MEDICATIONS.—(1) With respect 

16 to requirements relating to the licensing or credentialing 

17 of a network provider, the Secretary shall ensure that the 

18 network provider is able to submit prescriptions for phar19 maceutical agents on the formulary of the Department to 

20 pharmacies of the Department in a manner that is substan21 tially similar to the manner in which the network provider 

22 submits prescriptions to retail pharmacies. 

23 ‘‘(2) Nothing in this section shall be construed to affect 

24 the process of the Department for filling and paying for 

25 prescription medications. 


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1 ‘‘(j) QUALITY OF CARE.—In carrying out this section, 

2 the Secretary shall use the quality of care standards set 

3 forth or used by the Centers for Medicare & Medicaid Serv4 ices or other quality of care standards, as determined by 

5 the Secretary. 

6 ‘‘(k) CAPACITY AND COMMERCIAL MARKET ASSESS7 MENTS.—(1) On a periodic basis, but not less often than 

8 once every three years, the Secretary shall conduct an as9 sessment of the capacity of each Veterans Integrated Service 

10 Network and medical facility of the Department to furnish 

11 care or services under this chapter. Each such assessment 

12 shall— 

13 ‘‘(A) identify gaps in furnishing such care or 

14 services at such Veterans Integrated Service Network 

15 or medical facility; 

16 ‘‘(B) identify how such gaps can be filled by— 

17 ‘‘(i) entering into contracts or agreements 

18 with network providers under this section or 

19 with entities under other provisions of law; 

20 ‘‘(ii) making changes in the way such care 

21 and services are furnished at such Veterans Inte22 grated Service Network or medical facility, in23 cluding but not limited to— 

24 ‘‘(I) extending hours of operation; 

25 ‘‘(II) adding personnel; or 


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1 ‘‘(III) expanding space through con2 struction, leasing, or sharing of health care 

3 facilities; and 

4 ‘‘(iii) the building or realignment of De5 partment resources or personnel; 

6 ‘‘(C) forecast, based on future projections and 

7 historical trends, both the short- and long-term de8 mand in furnishing care or services at such Veterans 

9 Integrated Service Network or medical facility and 

10 assess how such demand affects the needs to use such 

11 network providers; 

12 ‘‘(D) include a commercial health care market 

13 assessment of designated catchment areas in the 

14 United States conducted by a nongovernmental enti15 ty; and 

16 ‘‘(E) consider the unique ability of the Federal 

17 Government to retain a presence in an area otherwise 

18 devoid of commercial health care providers or from 

19 which such providers are at a risk of leaving. 

20 ‘‘(2) The Secretary shall submit each assessment under 

21 paragraph (1) to the Committees on Veterans’ Affairs of the 

22 House of Representatives and the Senate and shall make 

23 each such assessment publicly available. 


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1 ‘‘(l) ALLOCATION OF FUNDS.—The Secretary shall de2 velop a plan for the allocation of funds in the Medical Com3 munity Care account. 

4 ‘‘(m) REPORTS ON RATES.—Not later than December 

5 31, 2019, and annually thereafter during each of the subse6 quent three years, the Secretary shall submit to the Commit7 tees on Veterans’ Affairs of the House of Representatives 

8 and the Senate a report detailing, for the fiscal year pre9 ceding the fiscal year during which the report is submitted, 

10 the rates paid by the Secretary for hospital care, medical 

11 services, or extended care services under this section that, 

12 pursuant to subsection (d)(3), are more than the rates de13 scribed in subsection (d)(2)(B) for the same care or services. 

14 ‘‘(n) DEFINITIONS.—In this section: 

15 ‘‘(1) The term ‘clean claim’ means a claim sub16 mitted— 

17 ‘‘(A) to the covered payer by a covered 

18 claimant for purposes of payment by the covered 

19 payer of expenses for hospital care or medical 

20 services furnished under this section; 

21 ‘‘(B) that contains substantially all of the 

22 required elements necessary for accurate adju23 dication, without requiring additional informa24 tion from the network provider; and 


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1 ‘‘(C) in such a nationally recognized format 

2 as may be prescribed by the Secretary for pur3 poses of paying claims for hospital care or med4 ical services furnished under this section. 

5 ‘‘(2) The term ‘covered claimant’ means— 

6 ‘‘(A) a network provider that submits a 

7 claim to the Secretary for purposes of payment 

8 by the Secretary of expenses for hospital care or 

9 medical services furnished under this section; or 

10 ‘‘(B) a regional network operated by a con11 tractor pursuant to subsection (a)(4)(B) that 

12 submits a claim to the Secretary for purposes of 

13 reimbursement for a payment made by the con14 tractor to a network provider for hospital care or 

15 medical services furnished under this section. 

16 ‘‘(3) The term ‘covered payer’ means— 

17 ‘‘(A) a regional network operated by a con18 tractor pursuant to subsection (a)(4)(B) with re19 spect to a claim made by a network provider to 

20 the contractor for purposes of payment by the 

21 contractor of expenses for hospital care or med22 ical services furnished under this section; or 

23 ‘‘(B) the Secretary with respect to— 

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1 ment by the Secretary of expenses for hos2 pital care or medical services furnished 

3 under this section; and 

4 ‘‘(ii) a claim made by a regional net5 work operated by a contractor pursuant to 

6 subsection (a)(4)(B) for purposes of reim7 bursement for a payment described by sub8 paragraph (A). 

9 ‘‘(4) The term ‘eligible veteran’ means a veteran 

10 who— 

11 ‘‘(A) is enrolled in the patient enrollment 

12 system of the Department established and oper13 ated under section 1705(a) of this title; and 

14 ‘‘(B) has— 

15 ‘‘(i) been furnished hospital care or 

16 medical services at or through a Depart17 ment facility on at least one occasion dur18 ing the two-year period preceding the date 

19 of the determination of eligibility; or 

20 ‘‘(ii) requested a first-time appoint21 ment for hospital care or medical services at 

22 a Department facility. 

23 ‘‘(5) The term ‘fraudulent claim’ means a claim 

24 by a network provider for reimbursement under this 

25 section that includes an intentional and deliberate 


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1 misrepresentation of a material fact or facts that is 

2 intended to induce the Secretary to pay an amount 

3 that was not legally owed to the provider.’’. 

4 (2) CLERICAL AMENDMENT.—The table of sec5 tions at the beginning of chapter 17 of such title is 

6 amended by inserting after the item relating to sec7 tion 1703 the following new item: 

‘‘1703A. VA Care in the Community Program.’’. 

8 (b) CONFORMING AMENDMENTS.—The Veterans Access, 

9 Choice, and Accountability Act of 2014 (Public Law 113– 

10 146) is amended— 

11 (1) in section 101(p)(1) (38 U.S.C. 1701 note), 

12 by inserting before the period at the end the following: 

13 ‘‘or the date on which the Secretary certifies to the 

14 Committees on Veterans’ Affairs of the House of Rep15 resentatives and the Senate that the Secretary is fully 

16 implementing section 1703A of title 38, United States 

17 Code, whichever occurs first’’; and 

18 (2) in section 208(1), by striking ‘‘section 101’’ 

19 and inserting ‘‘section 1703A of title 38, United 

20 States Code’’. 

21 (c) DEFINITIONS.—Section 1701 of title 38, United 

22 States Code, is amended by adding at the end the following 

23 new paragraphs: 

24 ‘‘(11) The term ‘network provider’ means any of 

25 the following health care providers that have entered 


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1 into a contract or agreement under which the pro2 vider agrees to furnish care and services to eligible 

3 veterans under section 1703A of this title: 

4 ‘‘(A) Any health care provider or supplier 

5 that is participating in the Medicare Program 

6 under title XVIII of the Social Security Act (42 

7 U.S.C. 1395 et seq.), including any physician 

8 furnishing services under such program. 

9 ‘‘(B) Any provider of items and services re10 ceiving payment under a State plan under title 

11 XIX of such Act (42 U.S.C. 1396 et seq.) or a 

12 waiver of such a plan. 

13 ‘‘(C) Any Federally-qualified health center 

14 (as defined in section 1905(l)(2)(B) of the Social 

15 Security Act (42 U.S.C. 1396d(l)(2)(B))). 

16 ‘‘(D) The Department of Defense. 

17 ‘‘(E) The Indian Health Service. 

18 ‘‘(F) Any health care provider that is an 

19 academic affiliate of the Department. 

20 ‘‘(G) Any health care provider not otherwise 

21 covered under any of subparagraphs (A) through 

22 (F) that meets criteria established by the Sec23 retary for purposes of such section. 

24 ‘‘(12) The term ‘VA Care in the Community Pro25 gram’ means the program under which the Secretary 


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1 furnishes hospital care or medical services to veterans 

2 through network providers pursuant to section 1703A 

3 of this title.’’. 

4 (d) TRANSITION OF PROVISION OF CARE.—This Act, 

5 and the amendments made by this Act, may not be con6 strued to affect the obligations of the Secretary of Veterans 

7 Affairs under contracts and agreements for the provision 

8 of hospital care, medical services, and extended care services 

9 entered into before the date of the enactment of this Act at 

10 the terms and rates contained in such contracts and agree11 ments. 

12 SEC. 103. VETERANS CARE AGREEMENTS. 

13 (a) IN GENERAL.—Subchapter I of chapter 17 of title 

14 38, United States Code, is further amended by inserting 

15 after section 1703A, as added by section 102, the following 

16 new section: 

17 ‘‘§ 1703B. Veterans Care Agreements with non-network 

18 providers 

19 ‘‘(a) VETERANS CARE AGREEMENTS.—(1) In addition 

20 to furnishing hospital care, medical services, or extended 

21 care services under this chapter at facilities of the Depart22 ment or under contracts or agreements entered into pursu23 ant to section 1703A of this title or any other provision 

24 of law other than this section, the Secretary may furnish 

25 such care and services to eligible veterans through the use 


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1 of agreements, to be known as ‘Veterans Care Agreements’, 

2 entered into under this section by the Secretary with eligible 

3 non-network providers. 

4 ‘‘(2) The Secretary may enter into a Veterans Care 

5 Agreement under this section with an eligible non-network 

6 provider if the Secretary determines that— 

7 ‘‘(A) the provision of the hospital care, medical 

8 services, or extended care services at a Department fa9 cility is impracticable or inadvisable because of the 

10 medical condition of the veteran, the travel involved, 

11 or the nature of the care or services required, or a 

12 combination of such factors; and 

13 ‘‘(B) such care or services are not available to be 

14 furnished by a non-Department health care provider 

15 under a contract or agreement entered into pursuant 

16 to a provision of law other than this section. 

17 ‘‘(3)(A) In accordance with subparagraphs (C) and 

18 (D), the Secretary shall review each Veterans Care Agree19 ment with a non-network provider to determine whether it 

20 is practical or advisable to, instead of carrying out such 

21 agreement— 

22 ‘‘(i) provide at a Department facility the hos23 pital care, medical services, or extended care services 

24 covered by such agreement; or 


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1 ‘‘(ii) enter into an agreement with the provider 

2 under section 1703A of this title to provide such care 

3 or services. 

4 ‘‘(B) If the Secretary determines pursuant to a review 

5 of a Veterans Care Agreement under subparagraph (A) that 

6 it is practical or advisable to provide hospital care, medical 

7 services, or extended care services at a Department facility, 

8 or enter into an agreement under section 1703A of this title 

9 to provide such care or services, as the case may be, the 

10 Secretary— 

11 ‘‘(i) may not renew the Veterans Care Agree12 ment; and 

13 ‘‘(ii) shall take such actions as are necessary to 

14 implement such determination. 

15 ‘‘(C) This paragraph shall apply with respect to Vet16 erans Care Agreements entered into with a non-network 

17 provider whose gross annual revenue, as determined under 

18 subsection (b)(1), exceeds— 

19 ‘‘(i) $3,000,000, in the case of a provider that 

20 furnishes homemaker or home health aide services; or 

21 ‘‘(ii) $1,000,000, in the case of any other pro22 vider. 

23 ‘‘(D) The Secretary shall conduct each review of a Vet24 erans Care Agreement under subparagraph (A) as follows: 


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1 ‘‘(i) Once during the 18-month period beginning 

2 on the date that is six months after date on which the 

3 agreement is entered into. 

4 ‘‘(ii) Not less than once during each four-year 

5 period beginning on the date on which the review 

6 under subparagraph (A) is conducted. 

7 ‘‘(b) ELIGIBLE NON-NETWORK PROVIDERS.—A pro8 vider of hospital care, medical services, or extended care 

9 services is eligible to enter into a Veterans Care Agreement 

10 under this section if the Secretary determines that the pro11 vider meets the following criteria: 

12 ‘‘(1) The gross annual revenue of the provider 

13 under contracts or agreements entered into with the 

14 Secretary in the year preceding the year in which the 

15 provider enters into the Veterans Care Agreement does 

16 not exceed— 

17 ‘‘(A) $5,000,000 (as adjusted in a manner 

18 similar to amounts adjusted pursuant to section 

19 5312 of this title), in the case of a provider that 

20 furnishes homemaker or home health aide serv21 ices; or 

22 ‘‘(B) $2,000,000 (as so adjusted), in the case 

23 of any other provider. 

24 ‘‘(2) The provider is not a network provider and 

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1 ices, or extended care services to patients pursuant to 

2 a contract entered into with the Department. 

3 ‘‘(3) The provider is— 

4 ‘‘(A) a provider of services that has enrolled 

5 and entered into a provider agreement under sec6 tion 1866(a) of the Social Security Act (42 

7 U.S.C. 1395cc(a)); 

8 ‘‘(B) a physician or supplier that has en9 rolled and entered into a participation agree10 ment under section 1842(h) of such Act (42 

11 U.S.C. 1395u(h)); 

12 ‘‘(C) a provider of items and services receiv13 ing payment under a State plan under title XIX 

14 of such Act (42 U.S.C. 1396 et seq.) or a waiver 

15 of such a plan; 

16 ‘‘(D) an Aging and Disability Resource 

17 Center, an area agency on aging, or a State 

18 agency (as defined in section 102 of the Older 

19 Americans Act of 1965 (42 U.S.C. 3002)); or 

20 ‘‘(E) a center for independent living (as de21 fined in section 702 of the Rehabilitation Act of 

22 1973 (29 U.S.C. 796a)). 

23 ‘‘(4) The provider is certified pursuant to the 

24 process established under subsection (c)(1). 


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1 ‘‘(5) Any additional criteria determined appro2 priate by the Secretary. 

3 ‘‘(c) PROVIDER CERTIFICATION.—(1) The Secretary 

4 shall establish a process for the certification of eligible pro5 viders to enter into Veterans Care Agreements under this 

6 section that shall, at a minimum, set forth the following: 

7 ‘‘(A) Procedures for the submission of applica8 tions for certification and deadlines for actions taken 

9 by the Secretary with respect to such applications. 

10 ‘‘(B) Standards and procedures for the approval 

11 and denial of certifications and the revocation of cer12 tifications. 

13 ‘‘(C) Procedures for assessing eligible providers 

14 based on the risk of fraud, waste, and abuse of such 

15 providers similar to the level of screening under sec16 tion 1866(j)(2)(B) of the Social Security Act (42 

17 U.S.C. 1395(j)(2)(B)) and the standards set forth 

18 under section 9.104 of title 48, Code of Federal Regu19 lations, or any successor regulation. 

20 ‘‘(D) Requirement for denial or revocation of cer21 tification if the Secretary determines that the other22 wise eligible provider is— 

23 ‘‘(i) excluded from participation in a Fed24 eral health care program (as defined in section 

25 1128B(f) of the Social Security Act (42 U.S.C. 


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1 1320a–7b(f))) under section 1128 or 1128A of the 

2 Social Security Act (42 U.S.C. 1320a–7 and 

3 1320a–7a); or 

4 ‘‘(ii) identified as an excluded source on the 

5 list maintained in the System for Award Man6 agement, or any successor system. 

7 ‘‘(E) Procedures by which a provider whose cer8 tification is denied or revoked under the procedures 

9 established under this subsection will be identified as 

10 an excluded source on the list maintained in the Sys11 tem for Award Management, or successor system, if 

12 the Secretary determines that such exclusion is appro13 priate. 

14 ‘‘(2) To the extent practicable, the Secretary shall es15 tablish the procedures under paragraph (1) in a manner 

16 that takes into account any certification process adminis17 tered by another department or agency of the Federal Gov18 ernment that an eligible provider has completed by reason 

19 of being a provider described in any of subparagraphs (A) 

20 through (E) of subsection (b)(4). 

21 ‘‘(3) The Secretary shall— 

22 ‘‘(A) verify upon enrollment, and annually 

23 thereafter, that eligible providers have not been ex24 cluded from participation in other federally funded 

25 health care programs; and 


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1 ‘‘(B) submit to the Committees on Veterans’ Af2 fairs of the House of Representatives and the Senate 

3 an annual report on the results of such verifications. 

4 ‘‘(d) TERMS OF AGREEMENTS.—Subsections (d), (e), 

5 (f), and (g) of section 1703A of this title shall apply with 

6 respect to a Veterans Care Agreement in the same manner 

7 such subsections apply to contracts and agreements entered 

8 into under such section. 

9 ‘‘(e) EXCLUSION OF CERTAIN FEDERAL CONTRACTING

10 PROVISIONS.—(1) Notwithstanding any other provision of 

11 law, the Secretary may enter into a Veterans Care Agree12 ment using procedures other than competitive procedures. 

13 ‘‘(2)(A) Except as provided in subparagraph (B) and 

14 unless otherwise provided in this section, an eligible non15 network provider that enters into a Veterans Care Agree16 ment under this section is not subject to, in the carrying 

17 out of the agreement, any provision of law that providers 

18 of services and suppliers under the original Medicare fee19 for-service program under parts A and B of title XVIII of 

20 the Social Security Act (42 U.S.C. 1395 et seq.) or the Med21 icaid program under title XIX of such Act (42 U.S.C. 1396 

22 et seq.) are not subject to. 

23 ‘‘(B) In addition to the provisions of laws covered by 

24 subparagraph (A), an eligible non-network provider shall 

25 be subject to the following provisions of law: 


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1 ‘‘(i) Any applicable law regarding integrity, eth2 ics, or fraud, or that subject a person to civil or 

3 criminal penalties. 

4 ‘‘(ii) Section 1352 of title 31, except for the fil5 ing requirements under subsection (b) of such section. 

6 ‘‘(iii) Section 4705 or 4712 of title 41, and any 

7 other applicable law regarding the protection of whis8 tleblowers. 

9 ‘‘(iv) Section 4706(d) of title 41. 

10 ‘‘(v) Title VII of the Civil Rights Act of 1964 (42 

11 U.S.C. 2000e et seq.) to the same extent as such title 

12 applies with respect to the eligible non-network pro13 vider in providing care or services through an agree14 ment or arrangement other than under a Veterans 

15 Care Agreement. 

16 ‘‘(f) TERMINATION OF A VETERANS CARE AGREE17 MENT.—(1) An eligible non-network provider may termi18 nate a Veterans Care Agreement with the Secretary under 

19 this section at such time and upon such notice to the Sec20 retary as the Secretary may specify for purposes of this sec21 tion. 

22 ‘‘(2) The Secretary may terminate a Veterans Care 

23 Agreement with an eligible non-network provider under this 

24 section at such time and upon such notice to the provider 


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1 as the Secretary may specify for the purposes of this section, 

2 if the Secretary determines necessary. 

3 ‘‘(g) DISPUTES.—(1) The Secretary shall establish ad4 ministrative procedures for providers with which the Sec5 retary has entered into a Veterans Care Agreement to 

6 present any dispute arising under or related to the agree7 ment. 

8 ‘‘(2) Before using any dispute resolution mechanism 

9 under chapter 71 of title 41 with respect to a dispute aris10 ing under a Veterans Care Agreement under this section, 

11 a provider must first exhaust the administrative procedures 

12 established by the Secretary under paragraph (1). 

13 ‘‘(h) AUTHORITY TO PAY FOR OTHER AUTHORIZED

14 SERVICES.—(1) If, in the course of an episode of care for 

15 which hospital care, medical services, or extended care serv16 ices are furnished to an eligible veteran pursuant to a Vet17 erans Care Agreement, any part of such care or services 

18 is furnished by a medical provider who is not an eligible 

19 non-network provider or a network provider, the Secretary 

20 may compensate such provider for furnishing such care or 

21 services. 

22 ‘‘(2) The Secretary shall make reasonable efforts to 

23 enter into a Veterans Care Agreement with any provider 

24 who is compensated pursuant to paragraph (1). 


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1 ‘‘(i) ANNUAL REPORTS.—(1) Not later than December 

2 31 of the year following the fiscal year in which the Sec3 retary first enters into a Veterans Care Agreement under 

4 this section, and each year thereafter, the Secretary shall 

5 submit to the appropriate congressional committees an an6 nual report that includes a list of all Veterans Care Agree7 ments entered into as of the date of the report. 

8 ‘‘(2) The requirement to submit a report under para9 graph (1) shall terminate on the date that is five years after 

10 the date of the enactment of this section. 

11 ‘‘(j) QUALITY OF CARE.—In carrying out this section, 

12 the Secretary shall use the quality of care standards set 

13 forth or used by the Centers for Medicare & Medicaid Serv14 ices or other quality of care standards, as determined by 

15 the Secretary. 

16 ‘‘(k) DELEGATION.—The Secretary may delegate the 

17 authority to enter into or terminate a Veterans Care Agree18 ment to an official of the Department at a level not below 

19 the Director of a Veterans Integrated Service Network or 

20 the Director of a Network Contracting Office. 

21 ‘‘(l) DEFINITIONS.—In this section: 

22 ‘‘(1) The term ‘appropriate congressional com23 mittees’ means— 

24 ‘‘(A) the Committees on Veterans’ Affairs of 

25 the House of Representatives and the Senate; and 


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1 ‘‘(B) the Committees on Appropriations of 

2 the House of Representatives and the Senate. 

3 ‘‘(2) The term ‘eligible veteran’ has the meaning 

4 given such term in section 1703A(m) of this title.’’. 

5 (b) CLERICAL AMENDMENT.—The table of sections at 

6 the beginning of such chapter is amended by inserting after 

7 the item relating to section 1703A, as added by section 102, 

8 the following new item: 

‘‘1703B. Veterans Care Agreements with non-network providers.’’. 

9 SEC. 104. MODIFICATION OF AUTHORITY TO ENTER INTO 

10 AGREEMENTS WITH STATE HOMES TO PRO11 VIDE NURSING HOME CARE. 

12 (a) USE OF AGREEMENTS.— 

13 (1) IN GENERAL.—Paragraph (1) of section 

14 1745(a) of title 38, United States Code, is amended, 

15 in the matter preceding subparagraph (A), by strik16 ing ‘‘a contract (or agreement under section 

17 1720(c)(1) of this title)’’ and inserting ‘‘an agree18 ment’’. 

19 (2) PAYMENT.—Paragraph (2) of such section is 

20 amended by striking ‘‘contract (or agreement)’’ each 

21 place it appears and inserting ‘‘agreement’’. 

22 (b) TREATMENT OF CERTAIN LAWS.—Such section is 

23 amended by adding at the end the following new paragraph: 

24 ‘‘(4)(A) An agreement under this section may be en25 tered into without regard to any law that would require 


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1 the Secretary to use competitive procedures in selecting the 

2 party with which to enter into the agreement. 

3 ‘‘(B)(i) Except as provided in clause (ii) and unless 

4 otherwise provided in this section or in regulations pre5 scribed pursuant to this section, a State home that enters 

6 into an agreement under this section is not subject to, in 

7 the carrying out of the agreement, any law to which pro8 viders of services and suppliers are not subject under the 

9 original Medicare fee-for-service program under parts A 

10 and B of title XVIII of the Social Security Act (42 U.S.C. 

11 1395 et seq.) or the Medicaid program under title XIX of 

12 such Act (42 U.S.C. 1396 et seq.). 

13 ‘‘(ii) The exclusion under clause (i) does not apply to 

14 laws regarding integrity, ethics, fraud, or that subject a per15 son to civil or criminal penalties. 

16 ‘‘(C) Title VII of the Civil Rights Act of 1964 (42 

17 U.S.C. 2000e et seq.) shall apply with respect to a State 

18 home that enters into an agreement under this section to 

19 the same extent as such title applies with respect to the 

20 State home in providing care or services through an agree21 ment or arrangement other than under this section.’’. 

22 (c) EFFECTIVE DATE.— 

23 (1) IN GENERAL.—The amendments made by 

24 this section shall apply to agreements entered into 

25 under section 1745 of such title on and after the date 


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1 on which the regulations prescribed by the Secretary 

2 of Veterans Affairs to implement such amendments 

3 take effect. 

4 (2) PUBLICATION.—The Secretary shall publish 

5 the date described in paragraph (1) in the Federal 

6 Register not later than 30 days before such date. 

7 SEC. 105. DEPARTMENT OF VETERANS AFFAIRS ELEC8 TRONIC INTERFACE FOR PROCESSING OF 

9 MEDICAL CLAIMS. 

10 (a) ELECTRONIC INTERFACE.—Not later than the im11 plementation date specified in section 108(a), the Chief In12 formation Officer of the Department of Veterans Affairs 

13 shall ensure that the information technology system used 

14 by the Department to receive, process, and pay claims 

15 under the VA Care in the Community Program established 

16 in section 1703A of title 38, United States Code, as added 

17 by section 102, and under Veterans Care Agreements estab18 lished in section 1703B of such title, as added by section 

19 103, includes the following: 

20 (1) A function through which a covered non-De21 partment health care provider may submit all re22 quired data and supporting information required for 

23 claims reimbursement through electronic data inter24 changes. 


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1 (2) An ability to automatically adjudicate 

2 claims. 

3 (3) A centralized claims database that is acces4 sible nationwide. 

5 (4) Integration with the relevant eligibility and 

6 authorization information technology systems of the 

7 Department. 

8 (5) Ability for a covered non-Department health 

9 care provider to ascertain the status of a pending 

10 claim submitted by the provider, receive information 

11 regarding missing documentation or discrepancies 

12 that may impede claim processing timelines or result 

13 in rejection, and receive notification when such claim 

14 is accepted for reimbursement or rejected. 

15 (6) A claim review system similar to that used 

16 by the Centers for Medicare & Medicaid Services, as 

17 of the date of the enactment of this Act, including the 

18 use of contractors to perform audits through data 

19 analytics, to determine the appropriateness and accu20 racy of claims of providers and to ensure program in21 tegrity and oversight. 

22 (b) SECURITY AND PRIVACY.—The Chief Information 

23 Officer shall also ensure that the information technology 

24 system covered under subsection (a) meets the following cri25 teria: 


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1 (1) Such system shall be developed and imple2 mented in compliance with all applicable laws, regu3 lations and Federal Government standards regarding 

4 information security, privacy, and accessibility. 

5 (2) Such system shall provide for the elicitation, 

6 analysis, and prioritization of functional and non7 functional information security and privacy require8 ments for such system, including security and privacy 

9 services and architectural requirements relating to se10 curity and privacy based on a thorough risk assess11 ment of all reasonably anticipated cyber and 

12 noncyber threats to the security and privacy of elec13 tronic protected health information made available 

14 through such interface. 

15 (3) Such system shall provide for the elicitation, 

16 analysis, and prioritization of secure development re17 quirements relating to such system. 

18 (4) Such system shall provide assurance that the 

19 prioritized information security and privacy require20 ments of such system— 

21 (A) are correctly implemented in the design 

22 and implementation of such system through the 

23 systems development lifecycle; and 


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1 (B) satisfy the information objectives of 

2 such system relating to security and privacy 

3 throughout the systems development lifecycle. 

4 (c) CONTRACT AUTHORITY.—The Chief Information 

5 Officer may enter into a contract for purposes of carrying 

6 out this section. 

7 (d) DEFINITIONS.—In this section: 

8 (1) The term ‘‘electronic protected health infor9 mation’’ has the meaning given that term in section 

10 160.103 of title 45, Code of Federal Regulations, as 

11 in effect on the date of the enactment of this Act. 

12 (2) The term ‘‘covered non-Department health 

13 care provider’’ means— 

14 (A) a network provider (as defined by sec15 tion 1701(11) of title 38, United States Code, as 

16 added by section 102); 

17 (B) a non-network provider with which the 

18 Secretary has entered into a Veterans Care 

19 Agreement under section 1703B of such title, as 

20 added by section 103; or 

21 (C) any other non-Department eligible pro22 vider or non-Department health care provider 

23 that furnishes hospital care or medical services 

24 pursuant to chapter 17 of such title. 


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1 (3) The term ‘‘secure development requirements’’ 

2 means, with respect to the information technology sys3 tem established under subsection (a), activities that 

4 are required to be completed during the system devel5 opment lifecycle of such interface, such as secure cod6 ing principles and test methodologies. 

7 (4) The term ‘‘VA Care in the Community Pro8 gram’’ has the meaning given that term in section 

9 1701(12) of title 38, United States Code, as added by 

10 section 102. 

11 SEC. 106. FUNDING FOR VA CARE IN THE COMMUNITY PRO12 GRAM. 

13 (a) IN GENERAL.—All amounts required to carry out 

14 the VA Care in the Community Program and Veterans Care 

15 Agreements under section 1703B of title 38, United States 

16 Code, shall be derived from the Veterans Health Adminis17 tration, Medical Community Care account. 

18 (b) TRANSFER OF AMOUNTS.— 

19 (1) IN GENERAL.—Any unobligated amounts in 

20 the Veterans Choice Fund under section 802 of the 

21 Veterans Access, Choice, and Accountability Act of 

22 2014 (Public Law 113–146; 38 U.S.C. 1701 note) 

23 shall be transferred to the Veterans Health Adminis24 tration, Medical Community Care account on the 

25 later of the following dates: 


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1 (A) The date that is one year after the date 

2 of the enactment of this Act. 

3 (B) The date on which the Secretary of Vet4 erans Affairs submits to the Committees on Vet5 erans’ Affairs of the Senate and the House of 

6 Representatives the certification required by sec7 tion 107(c). 

8 (2) CONFORMING REPEAL.— 

9 (A) IN GENERAL.—Effective immediately 

10 following the transfer of amounts under para11 graph (1), section 802 of the Veterans Access, 

12 Choice, and Accountability Act of 2014 (Public 

13 Law 113–146; 38 U.S.C. 1701 note) is repealed. 

14 (B) CONFORMING AMENDMENT.—Section 

15 4003 of the Surface Transportation and Veterans 

16 Health Care Choice Improvement Act of 2015 

17 (Public Law 114–41; 38 U.S.C. 1701 note) is 

18 amended by striking ‘‘for non-Department pro19 vider programs (as defined in section 2(d))’’ and 

20 all that follows through ‘‘1802)’’ and inserting 

21 the following: ‘‘for the VA Care in the Commu22 nity Program (as defined in section 1701(12) of 

23 title 38, United States Code) and Veterans Care 

24 Agreements under section 1703B of title 38, 

25 United States Code’’. 


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1 (c) VA CARE IN THE COMMUNITY PROGRAM DE2 FINED.—In this section, the term ‘‘VA Care in the Commu3 nity Program’’ has the meaning given that term in section 

4 1701(12) of title 38, United States Code, as added by section 

5 102. 

6 SEC. 107. TERMINATION OF CERTAIN PROVISIONS AUTHOR7 IZING MEDICAL CARE TO VETERANS 

8 THROUGH NON-DEPARTMENT OF VETERANS 

9 AFFAIRS PROVIDERS. 

10 (a) TERMINATION OF AUTHORITY TO CONTRACT FOR

11 CARE IN NON-DEPARTMENT FACILITIES.— 

12 (1) IN GENERAL.—Section 603of title 38, United 

13 States Code, is amended by adding at the end the fol14 lowing new subsection: 

15 ‘‘(e) The authority of the Secretary to carry out this 

16 section terminates on the date on which the Secretary cer17 tifies to the Committees on Veterans’ Affairs of the House 

18 of Representatives and the Senate that the Secretary is fully 

19 implementing section 1703A of this title.’’. 

20 (2) CONFORMING AMENDMENTS.— 

21 (A) DENTAL CARE.—Section 1712(a) of 

22 such title is amended— 

23 (i) in paragraph (3), by striking 

24 ‘‘under clause (1), (2), or (5) of section 

25 1703(a) of this title’’ and inserting ‘‘under 


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1 the VA Care in the Community Program’’; 

2 and 

3 (ii) in paragraph (4)(A), in the first 

4 sentence— 

5 (I) by striking ‘‘and section 1703 

6 of this title’’ and inserting ‘‘and the 

7 VA Care in the Community Program 

8 (with respect to such a year beginning 

9 on or after the date on which the Sec10 retary commences implementation of 

11 the VA Care in the Community Pro12 gram)’’; and 

13 (II) by striking ‘‘in section 1703 

14 of this title’’ and inserting ‘‘under the 

15 VA Care in the Community Program’’. 

16 (B) READJUSTMENT COUNSELING.—Section 

17 1712A(e)(1) of such title is amended by striking 

18 ‘‘(under sections 1703(a)(2) and 1710(a)(1)(B) 

19 of this title)’’ and inserting ‘‘(under the VA Care 

20 in the Community Program)’’. 

21 (C) DEATH IN DEPARTMENT FACILITY.— 

22 Section 2303(a)(2)(B)(i) of such title is amended 

23 by striking ‘‘in accordance with section 1703 of 

24 this title’’ and inserting ‘‘under the VA Care in 

25 the Community Program’’. 


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1 (D) MEDICARE PROVIDER AGREEMENTS.— 

2 Section 1866(a)(1)(L) of the Social Security Act 

3 (42 U.S.C. 1395cc(a)(1)(L)) is amended— 

4 (i) by striking ‘‘under section 1703 of 

5 title 38’’ and inserting ‘‘under the VA Care 

6 in the Community Program (as defined in 

7 section 1701(12) of title 38, United States 

8 Code)’’; and 

9 (ii) by striking ‘‘such section’’ and in10 serting ‘‘such program’’. 

11 (b) REPEAL OF AUTHORITY TO CONTRACT FOR

12 SCARCE MEDICAL SPECIALISTS.— 

13 (1) IN GENERAL.—Section 7409 of title 38, 

14 United States Code, is repealed. 

15 (2) CLERICAL AMENDMENT.—The table of sec16 tions at the beginning of chapter 74 of such title is 

17 amended by striking the item relating to section 7409. 

18 (c) EFFECTIVE DATE.—The amendments made by sub19 sections (a) and (b) shall take effect on the date on which 

20 the Secretary certifies to the Committees on Veterans’ Af21 fairs of the House of Representatives and the Senate that 

22 the Secretary is fully implementing section 1703A of title 

23 38, United States Code, as added by section 102. 


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1 SEC. 108. IMPLEMENTATION AND TRANSITION. 

2 (a) IMPLEMENTATION.—The Secretary of Veterans Af3 fairs shall commence the implementation of section 1703A 

4 of title 38, United States Code, as added by section 102, 

5 and section 1703B of such title, as added by section 103, 

6 and shall make the transfer under section 106(b), by not 

7 later than one year after the date of the enactment of this 

8 Act. The Secretary shall prescribe interim final regulations 

9 to implement such sections and publish such regulations in 

10 the Federal Register. 

11 (b) TRAINING.—Before commencing the implementa12 tion of sections 1703A and 1703B of title 38, United States 

13 Code, as added by sections 102 and 103, respectively, the 

14 Secretary of Veterans Affairs shall— 

15 (1) certify to the Committees on Veterans’ Affairs 

16 of the House of Representatives and the Senate that— 

17 (A) each network provider (as defined by 

18 section 1701(11) of title 38, United States Code) 

19 and eligible non-network provider that furnishes 

20 care or services under such section 1703A or sec21 tion 1703B is trained to furnish such care or 

22 services under such sections; and 

23 (B) each employee of the Department that 

24 refers, authorizes, or coordinates such care or 

25 services is trained to carry out such sections; and 


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1 (2) establish standard, written guidance for net2 work providers, non-Department health care pro3 viders, and any non-Department administrative enti4 ties acting on behalf of such providers, with respect to 

5 the policies and procedures for furnishing care or 

6 services under such sections. 

7 SEC. 109. TRANSPLANT PROCEDURES WITH LIVE DONORS 

8 AND RELATED SERVICES. 

9 (a) IN GENERAL.—Subchapter I of chapter 17 of title 

10 38, United States Code, is further amended by inserting 

11 after section 1703B, as added by section 103, the following 

12 new section: 

13 ‘‘§ 1703C. Transplant procedures with live donors and 

14 related services 

15 ‘‘(a) IN GENERAL.—Subject to subsections (b) and (c), 

16 in a case in which a veteran is eligible for a transplant 

17 procedure from the Department, the Secretary may provide 

18 for an operation on a live donor to carry out such procedure 

19 for such veteran, notwithstanding that the live donor may 

20 not be eligible for health care from the Department. 

21 ‘‘(b) OTHER SERVICES.—Subject to the availability of 

22 appropriations for such purpose, the Secretary shall furnish 

23 to a live donor any care or services before and after con24 ducting the transplant procedure under subsection (a) that 

25 may be required in connection with such procedure. 


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1 ‘‘(c) USE OF NON-DEPARTMENT FACILITIES.—(1) In 

2 carrying out this subsection, the Secretary may provide for 

3 the operation described in subsection (a) on a live donor 

4 and furnish to the live donor the care and services described 

5 in subsection (b) at a non-Department facility pursuant to 

6 an agreement entered into by the Secretary under this sec7 tion. The live donor shall be deemed to be an individual 

8 eligible for hospital care and medical services at a non-De9 partment facility pursuant to such an agreement solely for 

10 the purposes of receiving such operation, care, and services 

11 at the non-Department facility. 

12 ‘‘(2) The Secretary may only provide for an operation 

13 at a non-Department of Veterans Affairs transplant center 

14 pursuant to paragraph (1) if the center is in compliance 

15 with regulations prescribed by the Centers for Medicare & 

16 Medicaid Services applicable to transplant centers.’’. 

17 (b) CLERICAL AMENDMENT.—The table of section at 

18 the beginning of such chapter is further amended by insert19 ing after the item relating to section 1703B, as added by 

20 section 103, the following new item: 

‘‘1703C. Transplant procedures with live donors and related services.’’. 


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1 TITLE II—OTHER 

2 ADMINISTRATIVE MATTERS 

3 SEC. 201. REIMBURSEMENT FOR EMERGENCY AMBULANCE 

4 SERVICES. 

5 (a) IN GENERAL.—Section 1725(c) of title 38, United 

6 States Code, is amended by adding at the end the following 

7 new paragraph: 

8 ‘‘(5) In delineating the circumstances under which re9 imbursement may be made under this section for ambulance 

10 services for an individual, the Secretary shall treat such 

11 services as emergency services for which reimbursement may 

12 be made under this section if the Secretary determines 

13 that— 

14 ‘‘(A) the request for ambulance services was 

15 made as a result of the sudden onset of a medical con16 dition of such a nature that a prudent layperson who 

17 possesses an average knowledge of health and medi18 cine— 

19 ‘‘(i) would have reasonably expected that a 

20 delay in seeking immediate medical attention 

21 would have been hazardous to the life or health 

22 of the individual; or 

23 ‘‘(ii) could reasonably expect the absence of 

24 immediate medical attention to result in placing 

25 the health of the individual in serious jeopardy, 


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1 the serious impairment of bodily functions, or 

2 the serious dysfunction of any bodily organ or 

3 part; and 

4 ‘‘(B) the individual is transported to the most 

5 appropriate medical facility capable of treating such 

6 medical condition.’’. 

7 (b) EFFECTIVE DATE.—The amendment made by sub8 section (a) shall take effect on the date of the enactment 

9 of this Act and shall apply with respect to ambulance serv10 ices provided on or after January 1, 2019. 

11 SEC. 202. IMPROVEMENT OF CARE COORDINATION FOR 

12 VETERANS THROUGH EXCHANGE OF CERTAIN 

13 MEDICAL RECORDS. 

14 Section 7332(b) of title 38, United States Code, is 

15 amended— 

16 (1) in paragraph (2), by adding at the end the 

17 following new subparagraphs: 

18 ‘‘(I) To a public or private health care pro19 vider in order to provide treatment or health 

20 care to a shared patient. 

21 ‘‘(J) To a third party in order to recover or 

22 collect reasonable charges for care furnished to a 

23 veteran for a non-service-connected disability 

24 pursuant to section 1729 of this title or section 

25 1 of Public Law 87–693 (42 U.S.C. 2651).’’; and 


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1 (2) by adding at the end the following new para2 graph: 

3 ‘‘(4) Nothing in this section shall be construed to au4 thorize any provision of records in violation of relevant 

5 health record privacy laws, including the Health Insurance 

6 Portability and Accountability Act of 1996 (Public Law 

7 104–191).’’. 

8 SEC. 203. ELIMINATION OF COPAYMENT OFFSET. 

9 (a) IN GENERAL.—Section 1729(a) of title 38, United 

10 States Code, is amended by adding at the end the following 

11 new paragraph: 

12 ‘‘(4) Notwithstanding any other provision of law, 

13 any amount that the United States may collect or re14 cover under this section shall not affect any copay15 ment amount a veteran is otherwise obligated to pay 

16 under this chapter.’’. 

17 (b) EFFECTIVE DATE.—The amendment made by sub18 section (a) shall take effect on the date of the enactment 

19 of this Act and apply with respect to a copayment obliga20 tion that arises on or after the date of the enactment of 

21 this Act. 


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1 SEC. 204. USE OF DEPARTMENT OF VETERANS AFFAIRS 

2 MEDICAL CARE COLLECTIONS FUND FOR 

3 CERTAIN IMPROVEMENTS IN COLLECTIONS. 

4 Section 1729A(c)(1)(B) of title 38, United States Code, 

5 is amended by inserting ‘‘(including with respect to auto6 matic data processing or information technology improve7 ments)’’ after ‘‘collection’’. 

8 SEC. 205. DEPARTMENT OF VETERANS AFFAIRS HEALTH 

9 CARE PRODUCTIVITY IMPROVEMENT. 

10 (a) IN GENERAL.—Subchapter I of chapter 17 of title 

11 38, United States Code, is further amended by inserting 

12 after section 1705A the following new section: 

13 ‘‘§ 1705B. Management of health care: productivity 

14 ‘‘(a) RELATIVE VALUE UNIT TRACKING.—The Sec15 retary shall track relative value units for all Department 

16 providers. 

17 ‘‘(b) CLINICAL PROCEDURE CODING TRAINING.—The 

18 Secretary shall require all Department providers to attend 

19 training on clinical procedure coding. 

20 ‘‘(c) PERFORMANCE STANDARDS.—(1) The Secretary 

21 shall establish for each Department facility— 

22 ‘‘(A) in accordance with paragraph (2), stand23 ardized performance standards based on nationally 

24 recognized relative value unit production standards 

25 applicable to each specific profession in order to 


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1 evaluate clinical productivity at the provider and fa2 cility level; 

3 ‘‘(B) remediation plans to address low clinical 

4 productivity and clinical inefficiency; and 

5 ‘‘(C) an ongoing process to systematically review 

6 the content, implementation, and outcome of the plans 

7 developed under subparagraph (B). 

8 ‘‘(2) In establishing the performance standards under 

9 paragraph (1)(A), the Secretary may— 

10 ‘‘(A) incorporate values-based productivity mod11 els; and 

12 ‘‘(B) take into account non-clinical duties, in13 cluding with respect to training and research. 

14 ‘‘(d) DEFINITIONS.—In this section: 

15 ‘‘(1) The term ‘Department provider’ means an 

16 employee of the Department whose primary respon17 sibilities include furnishing hospital care or medical 

18 services, including a physician, a dentist, an optom19 etrist, a podiatrist, a chiropractor, an advanced prac20 tice registered nurse, and a physician’s assistant act21 ing as an independent provider. 

22 ‘‘(2) The term ‘relative value unit’ means a unit 

23 for measuring workload by determining the time, 

24 mental effort and judgment, technical skill, physical 

25 effort, and stress involved in delivering a procedure.’’. 


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1 (b) CLERICAL AMENDMENT.—The table of sections at 

2 the beginning of such chapter is further amended by insert3 ing after the item relating to section 1705A the following 

4 new item: 

‘‘1705B. Management of health care: productivity.’’. 

5 (c) REPORT.—Not later than one year after the date 

6 of the enactment of this Act, the Secretary shall submit to 

7 Congress a report on the implementation of section 1705B 

8 of title 38, United States Code, as added by subsection (a). 

9 Such report shall include, for each professional category of 

10 Department providers, the relative value unit of such cat11 egory of providers at the national, Veterans Integrated 

12 Service Network, and facility levels. 

13 SEC. 206. LICENSURE OF HEALTH CARE PROFESSIONALS OF 

14 THE DEPARTMENT OF VETERANS AFFAIRS 

15 PROVIDING TREATMENT VIA TELEMEDICINE. 

16 (a) IN GENERAL.—Chapter 17 of title 38, United 

17 States Code, is further amended by inserting after section 

18 1730A the following new section: 

19 ‘‘§ 1730B. Licensure of health care professionals pro20 viding treatment via telemedicine 

21 ‘‘(a) IN GENERAL.—Notwithstanding any provision of 

22 law regarding the licensure of health care professionals, a 

23 covered health care professional may practice the health 

24 care profession of the health care professional at any loca25 tion in any State, regardless of where the covered health 


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1 care professional or the patient is located, if the covered 

2 health care professional is using telemedicine to provide 

3 treatment to an individual under this chapter. 

4 ‘‘(b) PROPERTY OF FEDERAL GOVERNMENT.—Sub5 section (a) shall apply to a covered health care professional 

6 providing treatment to a patient regardless of whether the 

7 covered health care professional or patient is located in a 

8 facility owned by the Federal Government during such 

9 treatment. 

10 ‘‘(c) CONSTRUCTION.—Nothing in this section may be 

11 construed to remove, limit, or otherwise affect any obliga12 tion of a covered health care professional under the Con13 trolled Substances Act (21 U.S.C. 801 et seq.). 

14 ‘‘(d) COVERED HEALTH CARE PROFESSIONAL DE15 FINED.—In this section, the term ‘covered health care pro16 fessional’ means a health care professional who— 

17 ‘‘(1) is an employee of the Department appointed 

18 under the authority under section 7306, 7401, 7405, 

19 7406, or 7408 of this title, or title 5; 

20 ‘‘(2) is authorized by the Secretary to provide 

21 health care under this chapter; 

22 ‘‘(3) is required to adhere to all quality stand23 ards relating to the provision of telemedicine in ac24 cordance with applicable policies of the Department; 

25 and 


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1 ‘‘(4) has an active, current, full, and unrestricted 

2 license, registration, or certification in a State to 

3 practice the health care profession of the health care 

4 professional.’’. 

5 (b) CLERICAL AMENDMENT.—The table of sections at 

6 the beginning of chapter 17 of such title is further amended 

7 by inserting after the item relating to section 1730A the 

8 following new item: 

‘‘1730B. Licensure of health care professionals providing treatment via telemedicine.’’. 

9 (c) REPORT ON TELEMEDICINE.— 

10 (1) IN GENERAL.—Not later than one year after 

11 the date of the enactment of this Act, the Secretary of 

12 Veterans Affairs shall submit to the Committee on 

13 Veterans’ Affairs of the Senate and the Committee on 

14 Veterans’ Affairs of the House of Representatives a re15 port on the effectiveness of the use of telemedicine by 

16 the Department of Veterans Affairs. 

17 (2) ELEMENTS.—The report required by para18 graph (1) shall include an assessment of the following: 

19 (A) The satisfaction of veterans with tele20 medicine furnished by the Department. 

21 (B) The satisfaction of health care providers 

22 in providing telemedicine furnished by the De23 partment. 


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1 (C) The effect of telemedicine furnished by 

2 the Department on the following: 

3 (i) The ability of veterans to access 

4 health care, whether from the Department 

5 or from non-Department health care pro6 viders. 

7 (ii) The frequency of use by veterans of 

8 telemedicine. 

9 (iii) The productivity of health care 

10 providers. 

11 (iv) Wait times for an appointment for 

12 the receipt of health care from the Depart13 ment. 

14 (v) The reduction, if any, in the use by 

15 veterans of in-person services at Depart16 ment facilities and non-Department facili17 ties. 

18 (D) The types of appointments for the re19 ceipt of telemedicine furnished by the Depart20 ment that were provided during the one-year pe21 riod preceding the submittal of the report. 

22 (E) The number of appointments for the re23 ceipt of telemedicine furnished by the Depart24 ment that were requested during such period, 


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1 disaggregated by Veterans Integrated Service 

2 Network. 

3 (F) Savings by the Department, if any, in4 cluding travel costs, of furnishing health care 

5 through the use of telemedicine during such pe6 riod. 

7 SEC. 207. ESTABLISHMENT OF PROCESSES TO ENSURE 

8 SAFE OPIOID PRESCRIBING PRACTICES BY 

9 NON-DEPARTMENT OF VETERANS AFFAIRS 

10 HEALTH CARE PROVIDERS. 

11 (a) RECEIPT AND REVIEW OF GUIDELINES.—The Sec12 retary of Veterans Affairs shall ensure that all covered 

13 health care providers are provided a copy of and certify 

14 that they have reviewed the evidence-based guidelines for 

15 prescribing opioids set forth by the Opioid Safety Initiative 

16 of the Department of Veterans Affairs under sections 

17 911(a)(2) and 912(c) of the Jason Simcakoski Memorial 

18 and Promise Act (Public Law 114–198; 38 U.S.C. 1701 

19 note) before first providing care under the laws adminis20 tered by the Secretary and at any time when those guide21 lines are modified thereafter. 

22 (b) INCLUSION OF MEDICAL HISTORY AND CURRENT

23 MEDICATIONS.—The Secretary shall implement a process to 

24 ensure that, if care of a veteran by a covered health care 

25 provider is authorized under the laws administered by the 


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1 Secretary, the document authorizing such care includes the 

2 relevant medical history of the veteran and a list of all 

3 medications prescribed to the veteran. 

4 (c) SUBMITTAL OF PRESCRIPTIONS.— 

5 (1) IN GENERAL.—Except as provided in para6 graph (3), the Secretary shall require, to the max7 imum extent practicable, each covered health care 

8 provider to submit prescriptions for opioids— 

9 (A) to the Department for prior authoriza10 tion for the prescribing of a limited amount of 

11 opioids under contracts the Department has with 

12 retail pharmacies; or 

13 (B) directly to a pharmacy of the Depart14 ment for the dispensing of such prescription. 

15 (2) DEPARTMENT RESPONSIBILITY.—In carrying 

16 out paragraph (1), upon receipt by the Department of 

17 a prescription for opioids for a veteran under the 

18 laws administered by the Secretary, the Secretary 

19 shall— 

20 (A) record such prescription in the elec21 tronic health record of the veteran; and 

22 (B) monitor such prescription as outlined 

23 in the Opioid Safety Initiative of the Depart24 ment. 

25 (3) EXCEPTION.— 


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1 (A) IN GENERAL.—A covered health care 

2 provider is not required under paragraph (1)(B) 

3 to submit an opioid prescription directly to a 

4 pharmacy of the Department if— 

5 (i) the health care provider determines 

6 that there is an immediate medical need for 

7 the prescription, including an urgent or 

8 emergent prescription or a prescription dis9 pensed as part of an opioid treatment pro10 gram that provides office-based medications; 

11 and 

12 (ii)(I) following an inquiry into the 

13 matter, a pharmacy of the Department no14 tifies the health care provider that it cannot 

15 fill the prescription in a timely manner; or 

16 (II) the health care provider deter17 mines that the requirement under para18 graph (1)(B) would impose an undue hard19 ship on the veteran, including with respect 

20 to travel distances, as determined by the 

21 Secretary. 

22 (B) NOTIFICATION TO DEPARTMENT.—If a 

23 covered health care provider uses an exception 

24 under subparagraph (A) with respect to an 

25 opioid prescription for a veteran, the health care 


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1 provider shall, on the same day the prescription 

2 is written, submit to the Secretary for inclusion 

3 in the electronic health record of the veteran a 

4 notice, in such form as the Secretary may estab5 lish, providing information about the prescrip6 tion and describing the reason for the exception. 

7 (C) REPORT.— 

8 (i) IN GENERAL.—Not less frequently 

9 than quarterly, the Secretary shall submit 

10 to the Committee on Veterans’ Affairs of the 

11 Senate and the Committee on Veterans’ Af12 fairs of the House of Representatives a re13 port evaluating the compliance of covered 

14 health care providers with the requirements 

15 under this paragraph and setting forth data 

16 on the use by health care providers of excep17 tions under subparagraph (A) and notices 

18 under subparagraph (B). 

19 (ii) ELEMENTS.—Each report required 

20 by clause (i) shall include the following 

21 with respect to the quarter covered by the 

22 report: 

23 (I) The number of exceptions used 

24 under subparagraph (A) and notices 

25 received under subparagraph (B). 


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1 (II) The rate of compliance by the 

2 Department with the requirement 

3 under subparagraph (B) to include 

4 such notices in the health records of 

5 veterans. 

6 (III) The identification of any 

7 covered health care providers that, 

8 based on criteria prescribed the Sec9 retary, are determined by the Secretary 

10 to be statistical outliers regarding the 

11 use of exceptions under subparagraph 

12 (A). 

13 (d) USE OF OPIOID SAFETY INITIATIVE GUIDE14 LINES.— 

15 (1) IN GENERAL.—If a director of a medical cen16 ter of the Department or a Veterans Integrated Serv17 ice Network determines that the opioid prescribing 

18 practices of a covered health care provider conflicts 

19 with or is otherwise inconsistent with the standards 

20 of appropriate and safe care, as that term is used in 

21 section 913(d) of the Jason Simcakoski Memorial and 

22 Promise Act (Public Law 114–198; 38 U.S.C. 1701 

23 note), the director shall take such action as the direc24 tor considers appropriate to ensure the safety of all 

25 veterans receiving care from that health care provider, 


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1 including removing or directing the removal of any 

2 such health care provider from provider networks or 

3 otherwise refusing to authorize care of veterans by 

4 such health care provider in any program authorized 

5 under the laws administered by the Secretary. 

6 (2) INCLUSION IN CONTRACTS.—The Secretary 

7 shall ensure that any contracts entered into by the 

8 Secretary with third parties involved in admin9 istering programs that provide care in the community 

10 to veterans under the laws administered by the Sec11 retary specifically grant the authority set forth in 

12 paragraph (1) to such third parties and to the direc13 tors described in that paragraph, as the case may be. 

14 (e) DENIAL OR REVOCATION OF ELIGIBILITY OF NON15 DEPARTMENT PROVIDERS.—The Secretary shall deny or re16 voke the eligibility of a non-Department health care pro17 vider to provide health care to veterans under the laws ad18 ministered by the Secretary if the Secretary determines that 

19 the opioid prescribing practices of the provider— 

20 (1) violate the requirements of a medical license 

21 of the health care provider; or 

22 (2) detract from the ability of the health care 

23 provider to deliver safe and appropriate health care. 

24 (f) COVERED HEALTH CARE PROVIDER DEFINED.— 

25 In this section, the term ‘‘covered health care provider’’ 


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1 means a non-Department of Veterans Affairs health care 

2 provider who provides health care to veterans under the 

3 laws administered by the Secretary of Veterans Affairs. 

4 SEC. 208. ASSESSMENT OF HEALTH CARE FURNISHED BY 

5 THE DEPARTMENT TO VETERANS WHO LIVE 

6 IN THE TERRITORIES. 

7 (a) IN GENERAL.—Not later than 180 days after the 

8 date of the enactment of this Act, the Secretary of Veterans 

9 Affairs shall submit to the Committees on Veterans’ Affairs 

10 of the Senate and the House of Representatives a report re11 garding health care furnished by the Department of Vet12 erans Affairs to veterans who live in the territories. 

13 (b) ELEMENTS.—The report under subsection (a) shall 

14 include assessments of the following: 

15 (1) The ability of the Department to furnish to 

16 veterans who live in the territories the following: 

17 (A) Hospital care. 

18 (B) Medical services. 

19 (C) Mental health services. 

20 (D) Geriatric services. 

21 (2) The feasibility of establishing a medical facil22 ity of the Department in any territory that does not 

23 contain such a facility. 


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1 (c) DEFINITION.—In this section, the term ‘‘terri2 tories’’ means the Northern Mariana Islands, Puerto Rico, 

3 American Samoa, Guam, and the Virgin Islands. 

4 SEC. 209. OVERSIGHT AND ACCOUNTABILITY OF FINANCIAL 

5 PROCESSES OF DEPARTMENT OF VETERANS 

6 AFFAIRS. 

7 (a) SENSE OF CONGRESS.—It is the sense of Congress 

8 that— 

9 (1) the normal budget process for the Department 

10 of Veterans Affairs should be grounded in sound actu11 arial analysis based on accurate demand forecasting; 

12 (2) the regular budget process for the Department 

13 should be the norm; 

14 (3) supplemental requests for appropriations 

15 should be used sparingly and for unforeseen demand 

16 or natural occurrences; and 

17 (4) upon receipt of the financial audit of the Of18 fice of Inspector General of the Department, the Com19 mittee on Veterans’ Affairs of the Senate and the 

20 Committee on Veterans’ Affairs of the House of Rep21 resentatives shall give due consideration to the report, 

22 including by holding hearings as appropriate 

23 (b) PLANS FOR USE OF SUPPLEMENTAL APPROPRIA24 TIONS REQUIRED.—Whenever the Secretary submits to ad25 dress a budgetary issue affecting the Department of VetVerDate Sep 11 2014 20:57 Mar 05, 2018 Jkt 079200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6203 E:\BILLS\H4242.RH H4242

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1 erans Affairs to Congress a request for supplemental appro2 priations or any other appropriation when the request is 

3 submitted outside the standard budget process, the Secretary 

4 shall, not later than 45 days before the date on which such 

5 budgetary issue would start affecting a program or service, 

6 submit to Congress a justification for the request, including 

7 a plan that details how the Secretary intends to use the 

8 requested appropriation and how long the requested appro9 priation is expected to meet the needs of the Department 

10 and certification that the request was made using an up11 dated and sound actuarial analysis. 

12 (c) ANNUAL ATTESTATION REGARDING FINANCIAL

13 PROJECTIONS.—Concurrent with the President’s annual 

14 budget request submitted to Congress under section 1105 of 

15 title 31, United States Code, for fiscal year 2019 and each 

16 fiscal year thereafter, the Chief Financial Officer of the De17 partment of Veterans Affairs shall submit to the Committee 

18 on Veterans’ Affairs of the Senate and the Committee on 

19 Veterans’ Affairs of the House of Representatives the fol20 lowing: 

21 (1) A statement of assurance that financial pro22 jections included in such budget or the supporting 

23 materials submitted along with such budget for the 

24 Department of Veterans Affairs are sufficient to proVerDate Sep 11 2014 20:57 Mar 05, 2018 Jkt 079200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6203 E:\BILLS\H4242.RH H4242

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1 vide benefits and services under laws administered by 

2 the Secretary of Veterans Affairs. 

3 (2) A certification of the Chief Financial Offi4 cer’s responsibility for internal financial controls of 

5 the Department. 

6 (3) An attestation that the Chief Financial Offi7 cer has collaborated sufficiently with the financial of8 ficers of the facilities and components of the Depart9 ment to be confident in such financial projections. 

10 SEC. 210. AUTHORITY FOR DEPARTMENT OF VETERANS AF11 FAIRS CENTER FOR INNOVATION FOR CARE 

12 AND PAYMENT. 

13 (a) IN GENERAL.—Subchapter I of chapter 17, as 

14 amended by section 103, is further amended by inserting 

15 after section 1703C, as added by section 109, the following 

16 new section: 

17 ‘‘§ 1703D. Center for Innovation for Care and Payment 

18 ‘‘(a) IN GENERAL.—(1) There is established within the 

19 Department a Center for Innovation for Care and Payment 

20 (in this section referred to as the ‘Center’). 

21 ‘‘(2) The Secretary, acting through the Center, may 

22 carry out such pilot programs the Secretary determines to 

23 be appropriate to develop innovative approaches to testing 

24 payment and service delivery models in order to reduce exVerDate Sep 11 2014 20:57 Mar 05, 2018 Jkt 079200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6203 E:\BILLS\H4242.RH H4242

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1 penditures while preserving or enhancing the quality of care 

2 furnished by the Department. 

3 ‘‘(3) The Secretary, acting through the Center, shall 

4 test payment and service delivery models to determine 

5 whether such models— 

6 ‘‘(A) improve access to, and quality, timeliness, 

7 and patient satisfaction of care and services; and 

8 ‘‘(B) create cost savings for the Department. 

9 ‘‘(4)(A) The Secretary shall test a model in a location 

10 where the Secretary determines that the model will address11 es deficits in care (including poor clinical outcomes or po12 tentially avoidable expenditures) for a defined population. 

13 ‘‘(B) The Secretary shall focus on models the Secretary 

14 expects to reduce program costs while preserving or enhanc15 ing the quality of care received by individuals receiving 

16 benefits under this chapter. 

17 ‘‘(C) The models selected may include those described 

18 in section 1115A(b)(2)(B) of the Social Security Act (42 

19 U.S.C. 1315a(b)(2)(B)). 

20 ‘‘(5) In selecting a model for testing, the Secretary may 

21 consider, in addition to other factors identified in this sub22 section, the following factors: 

23 ‘‘(A) Whether the model includes a regular proc24 ess for monitoring and updating patient care plans 

25 in a manner that is consistent with the needs and 


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1 preferences of individuals receiving benefits under this 

2 chapter. 

3 ‘‘(B) Whether the model places the individual re4 ceiving benefits under this chapter at the center of the 

5 care team (including family members and other care6 givers) of such individual. 

7 ‘‘(C) Whether the model uses technology or new 

8 systems to coordinate care over time and across set9 tings. 

10 ‘‘(D) Whether the model demonstrates effective 

11 linkage with other public sector payers, private sector 

12 payers, or statewide payment models. 

13 ‘‘(6)(A) Models tested under this section may not be 

14 designed in such a way that would allow the United States 

15 to recover or collect reasonable charges from a Federal 

16 health care program for care or services furnished by the 

17 Secretary to a veteran under pilot programs carried out 

18 under this section. 

19 ‘‘(B) In this paragraph, the term ‘Federal health care 

20 program’ means— 

21 ‘‘(i) an insurance program described in section 

22 1811 of the Social Security Act (42 U.S.C. 1395c) or 

23 established by section 1831 of such Act (42 U.S.C. 

24 1395j); or 


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1 ‘‘(ii) a State plan for medical assistance ap2 proved under title XIX of such Act (42 U.S.C. 1396 

3 et seq.); or 

4 ‘‘(iii) a TRICARE program operated under sec5 tions 1075, 1075a, 1076, 1076a, 1076c, 1076d, 1076e, 

6 or 1076f of title 10. 

7 ‘‘(b) DURATION.—Each pilot program carried out by 

8 the Secretary under this section shall terminate no later 

9 than five years after the date of the commencement of the 

10 pilot program. 

11 ‘‘(c) LOCATION.—The Secretary shall ensure that each 

12 pilot program carried out under this section occurs in an 

13 area or areas appropriate for the intended purposes of the 

14 pilot program. 

15 ‘‘(d) BUDGET.—Funding for each pilot program car16 ried out by the Secretary under this section shall come from 

17 appropriations— 

18 ‘‘(1) provided in advance in appropriations acts 

19 for the Veterans Health Administration; and 

20 ‘‘(2) provided for information technology sys21 tems. 

22 ‘‘(e) NOTICE.—The Secretary shall— 

23 ‘‘(1) publish information about each pilot pro24 gram under this section in the Federal Register; and 


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1 ‘‘(2) take reasonable actions to provide direct no2 tice to veterans eligible to participate in such pilot 

3 programs. 

4 ‘‘(f) WAIVER OF AUTHORITIES.—(1) Subject to report5 ing under paragraph (2) and approval under paragraph 

6 (3), in implementing a pilot program under this section, 

7 the Secretary may waive such requirements in subchapters 

8 I, II, and III of this chapter as the Secretary determines 

9 necessary solely for the purposes of carrying out this section 

10 with respect to testing models described in subsection (a). 

11 ‘‘(2) Before waiving any authority under paragraph 

12 (1), the Secretary shall submit a report to the Speaker of 

13 the House of Representatives, the minority leader of the 

14 House of Representatives, the majority leader of the Senate, 

15 the minority leader of the Senate, and each standing com16 mittee with jurisdiction under the rules of the Senate and 

17 of the House of Representatives to report a bill to amend 

18 the provision or provisions of law that would be waived 

19 by the Department describing in detail the following: 

20 ‘‘(A) The specific authorities to be waived under 

21 the pilot program. 

22 ‘‘(B) The standard or standards to be used in the 

23 pilot program in lieu of the waived authorities. 

24 ‘‘(C) The reasons for such waiver or waivers. 


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1 ‘‘(D) A description of the metric or metrics the 

2 Secretary will use to determine the effect of the waiver 

3 or waivers upon the access to and quality, timeliness, 

4 or patient satisfaction of care and services furnished 

5 through the pilot program. 

6 ‘‘(E) The anticipated cost savings, if any, of the 

7 pilot program. 

8 ‘‘(F) The schedule for interim reports on the 

9 pilot program describing the results of the pilot pro10 gram so far and the feasibility and advisability of 

11 continuing the pilot program. 

12 ‘‘(G) The schedule for the termination of the pilot 

13 program and the submission of a final report on the 

14 pilot program describing the result of the pilot pro15 gram and the feasibility and advisability of making 

16 the pilot program permanent. 

17 ‘‘(H) The estimated budget of the pilot program. 

18 ‘‘(3)(A) Upon receipt of a report submitted under 

19 paragraph (2), each House of Congress shall provide copies 

20 of the report to the chairman and ranking member of each 

21 standing committee with jurisdiction under the rules of the 

22 House of Representatives or the Senate to report a bill to 

23 amend the provision or provisions of law that would be 

24 waived by the Department under this subsection. 


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1 ‘‘(B)(i) The waiver requested by the Secretary under 

2 paragraph (2) shall be considered approved under this 

3 paragraph if there is enacted into law a bill or joint resolu4 tion approving such request in its entirety. Such bill or 

5 joint resolution shall be passed by recorded vote to reflect 

6 the vote of each member of Congress thereon. 

7 ‘‘(ii) The provisions of this paragraph are enacted by 

8 Congress— 

9 ‘‘(I) as an exercise of the rulemaking power of 

10 the Senate and the House of Representatives and as 

11 such shall be considered as part of the rules of each 

12 House of Congress, and shall supersede other rules 

13 only to the extent that they are inconsistent therewith; 

14 and 

15 ‘‘(II) with full recognition of the constitutional 

16 right of either House of Congress to change the rules 

17 (so far as they relate to the procedures of that House) 

18 at any time, in the same manner, and to the same 

19 extent as in the case of any other rule of that House. 

20 ‘‘(C) During the 60-calendar-day period beginning on 

21 the date on which the Secretary submits the report described 

22 in paragraph (2) to Congress, it shall be in order as a mat23 ter of highest privilege in each House of Congress to consider 

24 a bill or joint resolution, if offered by the majority leader 


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1 of such House (or a designee), approving such request in 

2 its entirety. 

3 ‘‘(g) LIMITATIONS.—(1) The waiver provisions in sub4 section (f) shall not apply unless the Secretary, in accord5 ance with the requirements in subsection (f), submits the 

6 first proposal for a pilot program not later than 18 months 

7 after the date of the enactment of the VA Care in the Com8 munity Act. 

9 ‘‘(2) Notwithstanding section 502 of this title, decisions 

10 by the Secretary under this section shall, consistent with 

11 section 511 of this title, be final and conclusive and may 

12 not be reviewed by any other official or by any court, wheth13 er by an action in the nature of mandamus or otherwise. 

14 ‘‘(3)(A) If the Secretary determines that the pilot pro15 gram is not improving the quality of care or producing cost 

16 savings, the Secretary shall— 

17 ‘‘(i) propose a modification to the pilot program 

18 in the interim report that shall also be considered a 

19 report under subsection (f)(2)(A) and shall be subject 

20 to the terms and conditions of subsection (f)(2); or 

21 ‘‘(ii) terminate such pilot program not later 

22 than 30 days after submitting the interim report to 

23 Congress. 

24 ‘‘(B) If the Secretary terminates the pilot program 

25 under subparagraph (A)(ii), for purposes of clauses (vi) and 


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1 (vii) of subsection (f)(2)(A), such interim report will also 

2 serve as the final report for that pilot program. 

3 ‘‘(h) EVALUATION AND REPORTING REQUIREMENTS.— 

4 (1) The Secretary shall conduct an evaluation of each model 

5 tested, which shall include, at a minimum, an analysis of— 

6 ‘‘(A) the quality of care furnished under the 

7 model, including the measurement of patient-level 

8 outcomes and patient-centeredness criteria determined 

9 appropriate by the Secretary; and 

10 ‘‘(B) the changes in spending by reason of that 

11 model. 

12 ‘‘(2) The Secretary shall make the results of each eval13 uation under this subsection available to the public in a 

14 timely fashion and may establish requirements for other en15 tities participating in the testing of models under this sec16 tion to collect and report information that the Secretary 

17 determines is necessary to monitor and evaluate such mod18 els. 

19 ‘‘(i) COORDINATION AND CONSULTATION.—(1) The 

20 Secretary shall consult with the Under Secretary for Health 

21 and the Special Medical Advisory Group established pursu22 ant to section 7312 of this title in the development and im23 plementation of any pilot program operated under this sec24 tion. 


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1 ‘‘(2) In carrying out the duties under this section, the 

2 Secretary shall consult representatives of relevant Federal 

3 agencies, and clinical and analytical experts with expertise 

4 in medicine and health care management. The Secretary 

5 shall use appropriate mechanisms to seek input from inter6 ested parties. 

7 ‘‘(j) EXPANSION OF SUCCESSFUL PILOT PROGRAMS.— 

8 Taking into account the evaluation under subsection (f), the 

9 Secretary may, through rulemaking, expand (including im10 plementation on a nationwide basis) the duration and the 

11 scope of a model that is being tested under subsection (a) 

12 to the extent determined appropriate by the Secretary, if— 

13 ‘‘(1) the Secretary determines that such expan14 sion is expected to— 

15 ‘‘(A) reduce spending without reducing the 

16 quality of care; or 

17 ‘‘(B) improve the quality of patient care 

18 without increasing spending; and 

19 ‘‘(2) the Secretary determines that such expan20 sion would not deny or limit the coverage or provi21 sion of benefits for individuals receiving benefits 

22 under this chapter.’’. 

23 (b) CONFORMING AMENDMENT.—The table of sections 

24 at the beginning of such chapter, as amended by section 


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1 109, is further amended by inserting after the item relating 

2 to section 1703C the following new item: 

‘‘1703D. Center for Innovation for Care and Payment.’’. 

3 TITLE III—IMPROVEMENTS TO 

4 RECRUITMENT OF PHYSICIANS 

5 SEC. 301. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS 

6 AND DENTISTS UNDER DEPARTMENT OF VET7 ERANS AFFAIRS HEALTH PROFESSIONAL 

8 SCHOLARSHIP PROGRAM. 

9 (a) SCHOLARSHIPS FOR PHYSICIANS AND DEN10 TISTS.—Section 7612(b) of title 38, United States Code, is 

11 amended by adding at the end the following new paragraph: 

12 ‘‘(6)(A) Of the scholarships awarded under this sub13 chapter, the Secretary shall ensure that not less than 50 

14 scholarships are awarded each year to individuals who are 

15 accepted for enrollment or enrolled (as described in section 

16 7602 of this title) in a program of education or training 

17 leading to employment as a physician or dentist until such 

18 date as the Secretary determines that the staffing shortage 

19 of physicians and dentists in the Department is less than 

20 500. 

21 ‘‘(B) After such date, the Secretary shall ensure that 

22 of the scholarships awarded under this subchapter, a num23 ber of scholarships is awarded each year to individuals re24 ferred to in subparagraph (A) in an amount equal to not 

25 less than ten percent of the staffing shortage of physicians 


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1 and dentists in the Department, as determined by the Sec2 retary. 

3 ‘‘(C) Notwithstanding subsection (c)(1), the agreement 

4 between the Secretary and a participant in the Scholarship 

5 Program who receives a scholarship pursuant to this para6 graph shall provide the following: 

7 ‘‘(i) The Secretary’s agreement to provide the 

8 participant with a scholarship under this subchapter 

9 for a specified number (from two to four) of school 

10 years during which the participant is pursuing a 

11 course of education or training leading to employ12 ment as a physician or dentist. 

13 ‘‘(ii) The participant’s agreement to serve as a 

14 full-time employee in the Veterans Health Adminis15 tration for a period of time (hereinafter in this sub16 chapter referred to as the ‘period of obligated service’) 

17 of 18 months for each school year or part thereof for 

18 which the participant was provided a scholarship 

19 under the Scholarship Program. 

20 ‘‘(D) In providing scholarships pursuant to this para21 graph, the Secretary may provide a preference for appli22 cants who are veterans. 

23 ‘‘(E) On an annual basis, the Secretary shall provide 

24 to appropriate educational institutions informational maVerDate Sep 11 2014 20:57 Mar 05, 2018 Jkt 079200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6203 E:\BILLS\H4242.RH H4242

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1 terial about the availability of scholarships under this para2 graph.’’. 

3 (b) BREACH OF AGREEMENT.—Section 7617(b) of such 

4 title is amended— 

5 (1) by redesignating paragraphs (4) and (5) as 

6 paragraphs (5) and (6), respectively; and 

7 (2) by inserting after paragraph (3) the fol8 lowing new paragraph (4): 

9 ‘‘(4) In the case of a participant who is enrolled 

10 in a program or education or training leading to em11 ployment as a physician, the participant fails to suc12 cessfully complete post-graduate training leading to 

13 eligibility for board certification in a specialty.’’. 

14 (c) EXTENSION OF PROGRAM.—Section 7619 of such 

15 title is amended by striking ‘‘December 31, 2019’’ and in16 serting ‘‘December 31, 2033’’. 

17 SEC. 302. ESTABLISHMENT OF DEPARTMENT OF VETERANS 

18 AFFAIRS SPECIALTY EDUCATION LOAN RE19 PAYMENT PROGRAM. 

20 (a) IN GENERAL.—Chapter 76 of title 38, United 

21 States Code, is amended by inserting after subchapter VII 

22 the following new subchapter: 


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1 ‘‘SUBCHAPTER VIII—SPECIALTY EDUCATION 

2 LOAN REPAYMENT PROGRAM 

3 ‘‘§ 7691. Establishment 

4 ‘‘As part of the Educational Assistance Program, the 

5 Secretary may carry out a student loan repayment pro6 gram under section 5379 of title 5. The program shall be 

7 known as the Department of Veterans Affairs Specialty 

8 Education Loan Repayment Program (in this chapter re9 ferred to as the ‘Specialty Education Loan Repayment Pro10 gram’). 

11 ‘‘§ 7692. Purpose 

12 ‘‘The purpose of the Specialty Education Loan Repay13 ment Program is to assist, through the establishment of an 

14 incentive program for certain individuals employed in the 

15 Veterans Health Administration, in meeting the staffing 

16 needs of the Veterans Health Administration for physicians 

17 in medical specialties for which the Secretary determines 

18 recruitment or retention of qualified personnel is difficult. 

19 ‘‘§ 7693. Eligibility; preference; covered costs 

20 ‘‘(a) ELIGIBILITY.—An individual is eligible to par21 ticipate in the Specialty Education Loan Repayment Pro22 gram if the individual— 

23 ‘‘(1) is hired under section 7401 of this title to 

24 work in an occupation described in section 7692 of 

25 this title; 


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1 ‘‘(2) owes any amount of principal or interest 

2 under a loan, the proceeds of which were used by or 

3 on behalf of that individual to pay costs relating to 

4 a course of education or training which led to a de5 gree that qualified the individual for the position re6 ferred to in paragraph (1); and 

7 ‘‘(3) is— 

8 ‘‘(A) recently graduated from an accredited 

9 medical or osteopathic school and matched to an 

10 accredited residency program in a medical spe11 cialty described in section 7692 of this title; or 

12 ‘‘(B) a physician in training in a medical 

13 specialty described in section 7692 of this title 

14 with more than two years remaining in such 

15 training. 

16 ‘‘(b) PREFERENCE FOR VETERANS.—In selecting indi17 viduals for participation in the Specialty Education Loan 

18 Repayment Program under this subchapter, the Secretary 

19 may give preference to veterans. 

20 ‘‘(c) COVERED COSTS.—For purposes of subsection 

21 (a)(2), costs relating to a course of education or training 

22 include— 

23 ‘‘(1) tuition expenses; 


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1 ‘‘(2) all other reasonable educational expenses, 

2 including expenses for fees, books, equipment, and lab3 oratory expenses; and 

4 ‘‘(3) reasonable living expenses. 

5 ‘‘§ 7694. Specialty education loan repayment 

6 ‘‘(a) IN GENERAL.—Payments under the Specialty 

7 Education Loan Repayment Program shall consist of pay8 ments for the principal and interest on loans described in 

9 section 7682(a)(2) of this title for individuals selected to 

10 participate in the Program to the holders of such loans. 

11 ‘‘(b) FREQUENCY OF PAYMENT.—The Secretary shall 

12 make payments for any given participant in the Specialty 

13 Education Loan Repayment Program on a schedule deter14 mined appropriate by the Secretary. 

15 ‘‘(c) MAXIMUM AMOUNT; WAIVER.—(1) The amount of 

16 payments made for a participant under the Specialty Edu17 cation Loan Repayment Program may not exceed $160,000 

18 over a total of four years of participation in the Program, 

19 of which not more than $40,000 of such payments may be 

20 made in each year of participation in the Program. 

21 ‘‘(2)(A) The Secretary may waive the limitations 

22 under paragraph (1) in the case of a participant described 

23 in subparagraph (B). In the case of such a waiver, the total 

24 amount of payments payable to or for that participant is 


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1 the total amount of the principal and the interest on the 

2 participant’s loans referred to in subsection (a). 

3 ‘‘(B) A participant described in this subparagraph is 

4 a participant in the Program who the Secretary determines 

5 serves in a position for which there is a shortage of qualified 

6 employees by reason of either the location or the require7 ments of the position. 

8 ‘‘§ 7695. Choice of location 

9 ‘‘Each participant in the Specialty Education Loan 

10 Repayment Program who completes residency may select, 

11 from a list of medical facilities of the Veterans Health Ad12 ministration provided by the Secretary, at which such facil13 ity the participant will work in a medical specialty de14 scribed in section 7692 of this title. 

15 ‘‘§ 7696. Term of obligated service 

16 ‘‘(a) IN GENERAL.—In addition to any requirements 

17 under section 5379(c) of title 5, a participant in the Spe18 cialty Education Loan Repayment Program must agree, in 

19 writing and before the Secretary may make any payment 

20 to or for the participant, to— 

21 ‘‘(1) obtain a license to practice medicine in a 

22 State; 

23 ‘‘(2) successfully complete post-graduate training 

24 leading to eligibility for board certification in a spe25 cialty; 


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1 ‘‘(3) serve as a full-time clinical practice em2 ployee of the Veterans Health Administration for 12 

3 months for every $40,000 in such benefits that the em4 ployee receives, but in no case for fewer than 24 

5 months; and 

6 ‘‘(4) except as provided in subsection (b), to 

7 begin such service as a full-time practice employee by 

8 not later than 60 days after completing a residency. 

9 ‘‘(b) FELLOWSHIP.—In the case of a participant who 

10 receives an accredited fellowship in a medical specialty 

11 other than a medical specialty described in section 7692 

12 of this title, the Secretary, on written request of the partici13 pant, may delay the term of obligated service under sub14 section (a) for the participant until after the participant 

15 completes the fellowship, but in no case later than 60 days 

16 after completion of such fellowship. 

17 ‘‘(c) PENALTY.—(1) An employee who does not com18 plete a period of obligated service under this section shall 

19 owe the Federal Government an amount determined in ac20 cordance with the following formula: A=B×((T¥S)÷T)) . 

21 ‘‘(2) In the formula in paragraph (1): 

22 ‘‘(A) ‘A’ is the amount the employee owes the 

23 Federal Government. 


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1 ‘‘(B) ‘B’ is the sum of all payments to or for the 

2 participant under the Specialty Education Loan Re3 payment Program. 

4 ‘‘(C) ‘T’ is the number of months in the period 

5 of obligated service of the employee. 

6 ‘‘(D) ‘S’ is the number of whole months of such 

7 period of obligated service served by the employee. 

8 ‘‘§ 7697. Relationship to Educational Assistance Pro9 gram 

10 ‘‘Assistance under the Specialty Education Loan Re11 payment Program may be in addition to other assistance 

12 available to individuals under the Educational Assistance 

13 Program.’’. 

14 (b) CONFORMING AND TECHNICAL AMENDMENTS.— 

15 (1) CONFORMING AMENDMENTS.— 

16 (A) Section 7601(a) of title 38, United 

17 States Code, is amended— 

18 (i) in paragraph (4), by striking 

19 ‘‘and’’; 

20 (ii) in paragraph (5), by striking the 

21 period and inserting ‘‘; and’’; and 

22 (iii) by adding at the end the following 

23 new paragraph: 


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1 ‘‘(6) the specialty education loan repayment pro2 gram provided for in subchapter VIII of this chap3 ter.’’. 

4 (B) Section 7603(a)(1) of title 38, United 

5 States Code, is amended by striking ‘‘or VI’’ and 

6 inserting ‘‘VI, or VIII’’. 

7 (C) Section 7604 of title 38, United States 

8 Code, is amended by striking ‘‘or VI’’ each place 

9 it appears and inserting ‘‘VI, or VIII’’. 

10 (D) Section 7631 of title 38, United States 

11 Code, is amended— 

12 (i) in subsection (a)(1)— 

13 (I) by striking ‘‘and’’ after ‘‘schol14 arship amount,’’; and 

15 (II) by inserting ‘‘, and the max16 imum specialty education loan repay17 ment amount’’ after ‘‘reduction pay18 ments amount’’; and 

19 (ii) in subsection (b) by adding at the 

20 end the following new paragraph: 

21 ‘‘(7) The term ‘specialty education loan repayment 

22 amount’ means the maximum amount of specialty edu23 cation loan repayment payments payable to or for a partic24 ipant in the Department of Veterans Affairs Specialty Edu25 cation Loan Repayment Program under subchapter VIII of 


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1 this chapter, as specified in section 7694(c)(1) of this title 

2 and as previously adjusted (if at all) in accordance with 

3 this section.’’. 

4 (E) Section 7632 of title 38, United States 

5 Code, is amended— 

6 (i) in paragraph (1), by striking ‘‘and 

7 the Education Debt Reduction Program’’ 

8 and inserting ‘‘the Education Debt Reduc9 tion Program, and the Specialty Education 

10 Loan Repayment Program’’; and 

11 (ii) in paragraph (4), by striking ‘‘and 

12 per participant in the Education Debt Re13 duction Program’’ and inserting ‘‘per par14 ticipant in the Education Debt Reduction 

15 Program, and per participant in the Spe16 cialty Education Loan Repayment Pro17 gram’’. 

18 (2) TABLE OF SECTIONS.—The table of sections 

19 at the beginning of chapter 76 of such title is amend20 ed by inserting after the items relating to subchapter 

21 VII the following: 

‘‘SUBCHAPTER VIII—SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM

‘‘7691. Establishment. 

‘‘7692. Purpose. 

‘‘7693. Eligibility; preference; covered costs. 

‘‘7694. Specialty education loan repayment. 

‘‘7695. Choice of location. 

‘‘7696. Term of obligated service. 

‘‘7697. Relationship to Educational Assistance Program.’’. 


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1 (c) NEEDS OF THE VHA.—In making determinations 

2 each year under section 7692 of title 38, United States 

3 Code, as enacted by subsection (a), the Secretary of Veterans 

4 Affairs shall consider the anticipated needs of the Veterans 

5 Health Administration during the period two to six years 

6 in the future. 

7 (d) OFFER DEADLINE.—In the case of an applicant 

8 who applies before receiving a residency match and whom 

9 the Secretary of Veterans Affairs selects for participation 

10 in the Specialty Education Loan Repayment Program es11 tablished by subsection (a), the Secretary shall offer partici12 pation to the applicant not later than 28 days after— 

13 (1) the applicant matches with a residency in a 

14 medical specialty described in section 7692 of title 38, 

15 United States Code, as enacted by subsection (a); and 

16 (2) such match is published. 

17 (e) PUBLICITY.—The Secretary of Veterans Affairs 

18 shall take such steps as the Secretary determines are appro19 priate to publicize the Specialty Education Loan Repay20 ment Program established under subchapter VIII of chapter 

21 76 of title 38, United States Code, as enacted by subsection 

22 (a). 


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1 SEC. 303. VETERANS HEALING VETERANS MEDICAL ACCESS 

2 AND SCHOLARSHIP PROGRAM. 

3 (a) ESTABLISHMENT.—The Secretary of Veterans Af4 fairs, acting through the Office of Academic Affiliations of 

5 the Department of Veterans Affairs, shall carry out a pilot 

6 program under which the Secretary shall provide funding 

7 for the medical education of a total of 18 eligible veterans. 

8 Such funding shall be provided for two veterans enrolled 

9 in each covered medical schools in accordance with this sec10 tion. 

11 (b) ELIGIBLE VETERANS.—To be eligible to receive 

12 funding for medical education under this section, a veteran 

13 shall— 

14 (1) have been discharged from the Armed Forces 

15 not more than ten years before the date of application 

16 for admission to a covered medical school; 

17 (2) not be entitled to educational assistance 

18 under chapter 30, 31, 32, 33, 34, or 35 of title 38, 

19 United States Code, or chapter 1606 or 1607 of title 

20 10, United States Code; 

21 (3) apply for admission to a covered medical 

22 school for the entering class of 2019; 

23 (4) indicate on such application for admission 

24 that the veteran would like to be considered for an 

25 award of funding under this section; 


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1 (5) meet the minimum admissions criteria for 

2 the covered medical school to which the veteran ap3 plies; and 

4 (6) enter into an agreement described in sub5 section (e). 

6 (c) AWARD OF FUNDING.— 

7 (1) IN GENERAL.—Each covered medical school 

8 that opts to participate in the program under this 

9 section shall reserve two seats in the entering class of 

10 2019 for eligible veterans who receive funding under 

11 such program. Such funding shall be awarded to the 

12 two eligible veterans with the highest admissions 

13 rankings for such class at such school. 

14 (2) AMOUNT OF FUNDING.—Each eligible veteran 

15 who receives funding under this section shall receive 

16 an amount equal to the actual cost of— 

17 (A) tuition at the covered medical school at 

18 which the veteran enrolls for four years; 

19 (B) books, fees, and technical equipment; 

20 (C) fees associated with the National Resi21 dency Match Program; 

22 (D) two away rotations performed during 

23 the fourth year at a Department of Veterans Af24 fairs medical facility; and 


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1 (E) a monthly stipend for the four-year pe2 riod during which the veteran is enrolled in 

3 medical school in an amount to be determined by 

4 the Secretary. 

5 (3) DISTRIBUTION OF FUNDING.—In the event 

6 that two or more eligible veterans do not apply for 

7 admission at one of the covered medical schools for the 

8 entering class of 2019, the Secretary shall distribute 

9 the available funding to eligible veterans who applied 

10 for admission at other covered medical schools. 

11 (d) AGREEMENT.— 

12 (1) TERMS OF AGREEMENT.—Each eligible vet13 eran who accepts funding for medical education 

14 under this section shall enter into an agreement with 

15 the Secretary that provides that the veteran agrees— 

16 (A) to maintain enrollment and attendance 

17 in the medical school; 

18 (B) while enrolled in such medical school, to 

19 maintain an acceptable level of academic stand20 ing (as determined by the medical school under 

21 regulations prescribed by the Secretary); 

22 (C) to complete post-graduate training lead23 ing to eligibility for board certification in a spe24 ciality applicable to the Department of Veterans 

25 Affairs, as determined by the Secretary; 


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1 (D) after completion of medical school, to 

2 obtain a license to practice medicine in a State; 

3 and 

4 (E) after completion of medical school and 

5 post-graduate training, to serve as a full-time 

6 clinical practice employee in the Veterans Health 

7 Administration for a period of four years. 

8 (2) BREACH OF AGREEMENT.—If an eligible vet9 eran who accepts funding under this section breaches 

10 the terms of the agreement described in paragraph 

11 (1), the United States shall be entitled to recover 

12 damages in an amount equal to the total amount of 

13 such funding received by the veteran. 

14 (e) RULE OF CONSTRUCTION.—Nothing in this section 

15 shall be construed to prevent any covered medical school 

16 from accepting more than two eligible veterans for the enter17 ing class of 2019. 

18 (f) REPORT TO CONGRESS.—Not later than December 

19 31, 2020, and annually thereafter for the subsequent three 

20 years, the Secretary shall submit to Congress a report on 

21 the pilot program under this section. Such report shall in22 clude the evaluation of the Secretary of the success of the 

23 pilot program, including the number of veterans who re24 ceived funding under the program who matriculated and 

25 an evaluation of the academic progress of such veterans. 


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1 (g) COVERED MEDICAL SCHOOLS.—In this section, the 

2 term ‘‘covered medical school’’ means any of the following. 

3 (1) The Teague-Cranston medical schools, con4 sisting of— 

5 (A) Texas A&M College of Medicine; 

6 (B) Quillen College of Medicine at East 

7 Tennessee State University; 

8 (C) Boonshoft School of Medicine at Wright 

9 State University; 

10 (D) Joan C. Edwards School of Medicine at 

11 Marshall University; and 

12 (E) University of South Carolina School of 

13 Medicine. 

14 (2) Charles R Drew University of Medicine and 

15 Science. 

16 (3) Howard University College of Medicine. 

17 (4) Meharry Medical College. 

18 (5) Morehouse School of Medicine. 


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Union Calendar No. 444 

115TH CONGRESS 

2D SESSION H. R. 4242 

[Report No. 115–585] 

A BILL 

To amend title 38, United States Code, to establish 

gram, and for other purposes. a permanent VA Care in the Community ProMARCH 5, 2018 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 


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